Wiki Billing G Code for Chondroplasty to Private Payors

[bones555]

Does anyone bill the G code for chondroplasty to private payors. We know Medicare pays on this code and I was told it's not advisable to bill the G code to private payors because according to the carrier's health plan it's a non covered service and this could pose a red flag. We also had casualty payors tell us to use the G code... Any thoughts from anyone on this?

 

[JMeggett]

Does anyone bill the G code for chondroplasty to private payors. We know Medicare pays on this code and I was told it's not advisable to bill the G code to private payors because according to the carrier's health plan it's a non covered service and this could pose a red flag. We also had casualty payors tell us to use the G code... Any thoughts from anyone on this?

We're in Washington State and have 5 private carriers right now that all want us to bill G0289 when chondroplasty is performed in separate compartment from meniscectomy. They will bundle 29877-59 with meniscectomy, but on their fee schedule they allow reimbursement for G0289. We've been doing this for a few years and get paid for G0289....so I'm not sure why you've been told it's a non-covered service. Check with each individual carrier to see whether there is a medical policy regarding combo of chondro with meni's. Or check their fee schedules for G0289. I know of NO red flag issues regarding G0289.
Jenna

 

[maryanneheath]

We are also in Washington state and frequently use G0289 with no problems. I agree with Jenna above, you should check with each carrier to see what their policy is.

 

[jdemar]

I also, have some private payors that require the G0289.

 

[bones555]

G Code for Chondroplasty

Thanks!!! We have been billing the G Code but I got worried and held off recently when I was told we were "faking out the insurance company" by using this code.