Wiki ASC Billing & Payment of Add on Codes


Phoenix, AZ
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Hello everyone and thank you in advance to whomever might have given feedback and help.:eek:
I am looking for information on the Add on codes when billed to Medicare from an ASC. I have found the payments that Medicare makes to the ASC but one of the things not listed is the add on codes, IE 64494 - 64495 & 64634 & 64636. My doctor is a Pain Management Specialist in AZ and he has been offered to become a partner at an ASC and he wanted me to gather info. I have never billed nor worked for an ASC so I am not sure how that works. I am looking for Medicare info only, at this time and I do know that there is a technical component for the add on. Any information or help would be greatly appreciated, thank you.
Medicare does not make separate payment for add-on codes in most cases - these codes are assigned an 'N1' payment indicator on the ASC fee schedule which means 'packaged service/item; no separate payment made'. It's not a denial, it's just that the facility payment that is made for the base code is a case rate that includes any add-on codes that may or may not have been performed. Even though you don't get additional payment for the add-on codes, though, you still need to bill them. The reporting of the codes is important because it's used to measure utilization which determines the rate calculations for future fee schedules, so in theory at least you'll get credit for this work with higher rates when the fee schedules are revised.