Wiki ASC Billing for injections, Medicare

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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
 
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
 
?

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!
 
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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