Part B Insider (Multispecialty) Coding Alert

Published on Fri Jun 24, 2005 PDF

Carriers can charge for running seminars

If you've been trying to bill Medicare for new stereotactic radiosurgery code 0083T, then one hurdle to coverage has just been lifted.

Part B carriers were denying claims for 0083T because they thought it was a Part A-only code, reports Linda Lively, president and CEO of American Medical Accounting & Consulting in Atlanta. The code describes physician services, but the carriers had categorized it incorrectly.

Lively raised this concern at the July 15 Medicare physician Open Door Forum conference call. And shortly afterward, she heard from Part B carrier Empire Blue Cross Blue Shield that it had recategorized the code as a Part B code. But Empire staff added that the carrier would deny 0083T as experimental, Lively relates.

Medicare carriers aren't required to cover category III codes such as 0083T, but some will on a case-by-case basis. In the case of 0083T, at least one carrier has promised to reimburse the code in some instances (See PBI, vol. 6, no. 8). Some private payors are covering the code, Lively says.

Separately, Lively's colleague Sharon McKinsey raised a question in the Forum about coverage for stereotactic radiosurgery in freestanding facilities. Medicare has said it won't cover the procedure in the freestanding setting because "G" codes such as G0243, G0251 and G0339 are designated only for the hospital setting. But Centers for Medicare and Medicaid Services officials said they would look into the issue further. Providers still are hoping for new CPT codes for stereotactic radiosurgery, which Medicare might reimburse in the freestanding setting (See PBI, Vol. 5, no. 25).

During the ODF call, CMS officials also revealed that: