ajperretta1
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Greetings!
Did a search but could not find an answer to these questions.
Fact Pattern:
An ASC bill has three CPT Codes on it - 29823, 29825-59 and 29826.
They all share EAPG Code 37, and all are Level I Arthroscopy.
29823 is paid at 100% of its value, and 29825-59 is paid at 50% of its value due to Mod 59.
That leaves me with two questions regarding 29826, our wonderful add-on code.
1) Does 29826 require Modifier 59 to be reimbursed within the EAPG framework, despite the fact that it is an add-on code?
2) Assuming 29826 is reimbursable - Modifier 59 or not - would it be reimbursed at 50% or 100%, because this is an ASC subject to EAPG?
And if people have links to sources or authorities on these issues, I would GREATLY appreciate it!
Thanks in advance everyone!!
Did a search but could not find an answer to these questions.
Fact Pattern:
An ASC bill has three CPT Codes on it - 29823, 29825-59 and 29826.
They all share EAPG Code 37, and all are Level I Arthroscopy.
29823 is paid at 100% of its value, and 29825-59 is paid at 50% of its value due to Mod 59.
That leaves me with two questions regarding 29826, our wonderful add-on code.
1) Does 29826 require Modifier 59 to be reimbursed within the EAPG framework, despite the fact that it is an add-on code?
2) Assuming 29826 is reimbursable - Modifier 59 or not - would it be reimbursed at 50% or 100%, because this is an ASC subject to EAPG?
And if people have links to sources or authorities on these issues, I would GREATLY appreciate it!
Thanks in advance everyone!!