Wiki add on code reimbursement question

[Jillian Sherwood]

Wondering if any one can help out... do add on codes get paid out in full per allowed amount when they are in large quantities? Per instance, 14301 and then add on code 14302 x 10.... would the 14302 x10 get paid in full or would each the first 14302 get paid in full then each additional one get paid in half, then 1/3?

 

[thomas7331]

Under CMS reimbursement methodology for physician services (and for payers that follow CMS or use RVU pricing), add-on codes are not subject to multiple procedure reductions and should always pay at full value. Since these codes are procedures that are always done in conjunction with another procedure, the reductions are already calculated into the code's value. CMS and some payers do, however, have maximum unit edits and may only pay up to a certain number of units - if you exceed that, you may have to appeal with records to get the correct number of units paid.

 

[Jillian Sherwood]

Thank you!!!!