Dermatology Coding Alert
Check Local Payers Before Billing With 96567
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Question: Would you tell me how to code for photodynamic therapy treatments? Should I bill for the ALA cream separately? Are insurance companies covering this procedure? Answer: When you code for photodynamic therapy, use code 96567 (Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa [e.g., lip] by activation of photosensitive drug[s], each phototherapy exposure session).
New York Subscriber
Medicare recently clarified that payments are approved for the agent used with photodynamic therapy. To report the agent, use your HCPCS book. Look under the table of drugs. You should find a cross reference to the agent you used. If you can't find a cross reference for the agent, check the packaging for the agent. The generic name should appear in the literature. Look up the drug in the table of drugs by the generic name.
Be aware that payers may vary in their payment policies for agents. Locate the policy for each of your major payers and follow the guidelines outlined. If guidelines cannot be met, have the patient sign an ABN waiver, and collect from your patient.
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Check Local Payers Before Billing With 96567
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