billing ASC Medicare implants

paula f3

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Hello,
Wondering if any free standing ASC has billed Medicare for ACL (29888) w/ graft (L8699) and been paid. I called our local LCD and they assured me were covered services , but to be very precise in our description along w/ invoices. I am apprehensive being that this will be our first Medicare pt.Any input would be greatly appreciated.
 

mbort

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I hate to be the bearer of bad news, but whomever you spoke with at your local Medicare FI, didnt know what they were talking about (sad but true).

If you go through the HCPC book (one that has the payment indicators) you will see that the majority of the payment indicators are N1. Medicare pays for very little..and implants for orthopedic cases are not one of them. I used C1762 for my ACL allografts, it has an N1 payment indicator. L8699 has an N1, C1713 has an N1, L8642 (which they used to pay) is now an N1.

Prior to Jan 2008, Medicare did pay for some of these items with invoices and the description of the implant in box 19, however that changed.

Unless you can get Medicare to give you something in WRITING (good luck with that) stating they will pay for it, I can only encourage you to try to defer the case.
 

paula f3

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Thanks for the input. I had a gut feeling that info was given to me from our local not quite right.

PF
 
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