Wiki 23472 IPO List

[pinnaclephyserv]

I keep reading that we can perform 23472 in ASC, but Medicare is denying the procedure. I am confused.

Any input is helpful!

 

[amyjph]

What is the denial reason?

 

[pinnaclephyserv]

Not allowed in this type of setting.. When I check the fee schedule for ASC 23472 doesn't have a fee

 

[thomas7331]

Not allowed in this type of setting.. When I check the fee schedule for ASC 23472 doesn't have a fee

CPT code 23472 is not an inpatient-only procedure, but it is listed on Addendum EE of the ASC payment files - 'surgical procedures to be excluded from payment in ASCs for CY 2022'. So Medicare will not reimburse this to an ASC.

You can find the complete list here: ASC Payment Rates - Addenda | CMS

 

[pinnaclephyserv]

I read that and I was so confused. How can it not be an inpatient-only procedure but excluded from payment..

Thank you!