Wiki Add On Codes In Pain Management

[Donna SanGiovanni]

I have been asked this question- When an ASC is used for CPT Codes 64475-rt/lt, 64476-rt/lt the carriers are paying 100%, 50%, 50%, 50%. The coder is stating multiple rules do not apply to add on codes. She feels the claim should be paid as follows:
64475 rt 100%
64475 lt 50%
64476 rt 100%
64476 lt 50%
We do not do these injections where I work. Please advise.

Donna SanGiovanni CPC
President/Founder Hamden CT. Local Chapter

 

[elenax]

Add-on codes

I have billed with those cpt's and they pay as follows: 100%, 50%, 50%, 50%. The multiple procedures rules does apply.

 

[cconroycpch]

I agree, the multiple procedure rule does apply. I have worked with multiple facilities doing those procedures and they always pay 100%, 50%, 50%, 50%