ASC Billing for injections, Medicare

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1
Location
Bixby, OK
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I need help with billing injections. Providers are performing multiple levels, but only the first level is covered under Novitas. What do I need to do to get these paid? It has been suggested to billed the covered code @ 3x, and I don't agree.
Is there a modifier that I should use? 50 or SG?

64491
64492
64494

64634
64636
 

jshore

Contributor
Messages
10
Location
Saint Clair Shores, MI
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Hello,
When billing injection procedures to Medicare that are performed at an ASC you can only bill the primary injection code. All add-on codes are not payable with Medicare. Also, you would use modifiers RT and LT for bilateral procedures instead of -50. I also found that Medicare will only pay 1 side if modifier -51 (multiple procedures) is not appended to the 2nd code, so also append -51 to the second code.

For example:

64490 -RT
64490 -LT, -51

I hope this helps!
Jean
 
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1
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?

I am working with a HCP who is going to start doing botulinum toxin injections in the ASC. I have very little experience with that. Can you look at what my thought are and let me know if I am on the right track?

ASC will bill - CPT - 64616 RT TC, 64616 LT 51 TC and the drug J0587 on 1500 form
HCP will bill - CPT 64616 50 on 1500 form

Thanks!
 

jshore

Contributor
Messages
10
Location
Saint Clair Shores, MI
Best answers
0
I am working with a HCP who is going to start doing botulinum toxin injections in the ASC. I have very little experience with that. Can you look at what my thought are and let me know if I am on the right track?

ASC will bill - CPT - 64616 RT TC, 64616 LT 51 TC and the drug J0587 on 1500 form
HCP will bill - CPT 64616 50 on 1500 form

Thanks!

Medicare will pay 64616 and J0587 per the ASC fee schedule (October 2016). Based on the information you gave, I would code for the facility fee:
64616 -RT
64616 -LT -51
J0587

The HCP would bill 64616 -50

Hope this helps!
Jean
 
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