64490, 64491, 64492; 64493, 64494, 64495 MBB

[Jdeleon]

Can someone help me with MBB? Does Medicare only pay for the initial MBB and not the add on's? It seems we are only getting payment for the initial injection? Any and all information would be appreciated. Thank you!

 

[jkyles]

Hi there, could you please provide the denial message(s) you're receiving? And are you getting the denial on the 3rd and additional level (64492 and 64495) or for any add-on code?

 

[amyjph]

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58405&ver=8&keyword=&keywordType=starts&areaId=s5&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=64490&hcpcsEndCode=64490&sortBy=title&bc=1

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58477&ver=13&keyword=&keywordType=starts&areaId=s5&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=64490&hcpcsEndCode=64490&sortBy=title&bc=1

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=38803

"One to 2 levels, either unilateral or bilateral, are allowed per session per spine region (i.e., 2 unilateral or to 2 bilateral levels per session)."
"Each unilateral or bilateral intervention at any level should be reported as 1 unit, with bilateral intervention signified by appending the modifier -50."