Wiki ASC Facility Claim- 0201T

[jshore]

Hello,
I am an ASC facility coder and I have been trying to help the billers with getting a few Sacroplasty, bilateral (0201T) claims paid by Medicare. Why does our local Medicare carrier show 0201T as an approved payable ASC procedure, yet continues to deny the facility claim as investigational/experimental? Also, there are no LCD requirements for Michigan MAC Part B (J8).

The payment rate for our Medicare local carrier (Detroit, MI 01-8202 ) is as follows:

ASC Payment Amount: $2,744.32
Payment Indicator: G2
Status Indicator: J1

Claims have been billed with diagnosis code M48.48XA.

Please, if anyone has suggestions on how to get these claims paid I would very much appreciate it.

Thank you!
Jean S. COC, CASCC

 

[CodingKing]

I'm not sure why I rarely see LCDs from WPS Medicare. NGS, Palmetto, FCSO & Novitas list as not covered.

 

[jshore]

I think I figured out why these procedures are not getting paid.....the doctors need to register for the clinical trial and then the trial # along with modifier Q0 and diagnosis Z00.6 need to be billed on the claim. Unfortunately the clinical trial is complete for bilateral sacroplasty (0201T) so we won't be paid on these since the doctors didn't register. I don't believe we can submit these claims with the clinical trial number without being registered.

Jean S. COC, CASCC