Wiki 64483, 64484 add-on charges

[mamador2]

I work in a general clinic/pain management office, we have an anesthesiologist/pain specialist come in and do facet blocks/ TPI, the charges for the initial first level block, but there are no charges entered into our fee schedule for the add-on 64484, couldn't find a charge for it, pt has private insurance, not Medicaid/medicare. Should I call the insurance OR does anyone here know what the charge is for this procedure.

Still new to coding, any help is appreciated, thank you!

 

[dwaldman]

I would try to confirm if there is currently someone at the location that maintains and updates the chargemaster with the new codes each year that are released and potentially set up codes for new services. If you have taken over for an employee who was previously responsible for this, then you could find out if they have a formula that they used to set up their charge master fees for the services. If not then you could review the way the current charges are set up compared to the Medicare fee schedule and potentially set up a fee based on a accepted formula by the necessary members at the practice to capture the accurate cost for the service.

 

[dwaldman]

Additionally, you would first want to obtain the Medicare allowable which for in a facility setting is around $54.09 and in an office setting $89.56 for CPT 64484.

When setting up the fee, does the service represent the same charge master cost as the primary procedure or does the practice believe that the additional levels are at a lower rate which would be similar to how it is calculated from a reimbursement standpoint.

Another thing to consider once your fee is set, if the billed charges are paid at a percentage per a certain payer contract, typically your charge master fee times that percentage should not fall below the Medicare allowable or be unrealistically higher than the Medicare allowable to ensure accurate and fee amount that is fair to the patient's potential deductible and payer.