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ASC Implant Billing

armen

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Atlanta
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Does anyone bill for kwires, screws/plates or other implants? What code do you use and do you bill to Medicare? thanks!
 

JMeggett

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Does anyone bill for kwires, screws/plates or other implants? What code do you use and do you bill to Medicare? thanks!
Yes, we bill those items from our ASC and we use L8699. But Medicare does not reimburse for L8699, even on appeal. For Medicare those items are bundled in with the reimbursement for the procedure. If you do a Forum Search & type in "implant"...86 threads come up with all kinds of info for you! ;)

Jenna
 

armen

Guest
Messages
335
Location
Atlanta
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Yes, we bill those items from our ASC and we use L8699. But Medicare does not reimburse for L8699, even on appeal. For Medicare those items are bundled in with the reimbursement for the procedure. If you do a Forum Search & type in "implant"...86 threads come up with all kinds of info for you! ;)

Jenna
Do you know if our contract with commercial payers should have L8699 as an implant code? We have a contract with CIGNA to reimburse implants but I billed them with cpt 99070 and CIGNA denied statig this code is not on our fee schedule.
 

JMeggett

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226
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Do you know if our contract with commercial payers should have L8699 as an implant code? We have a contract with CIGNA to reimburse implants but I billed them with cpt 99070 and CIGNA denied statig this code is not on our fee schedule.
We do have "carve-out's" in our contracts with several of our biggest payors and I attach a copy to each ASC claim I send with an L8699 on it, along with the Op note. On our carve-out's the L8699 is listed as payable...but 99070 is not for implant items, so if it's implants your talking about then I wonder if you should change what you billed out? 99070 is always bundled in to the procedure CPT or E&M code you bill with it. If it's not on their fee schedule then it'll never be payable, even with contract set up.
Jenna
 
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