billing HCPCS 0438T

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Have you checked your local MAC for any LCDs? I did a quick search and found a whole lot of "non-covered" LCDs.
 
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Waltham, MA
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billing HCPCS/CPT 0438T

You can use CPT code 0438T - Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance. This is an all-inclusive code (procedure and product) and may be used for both professional and technical components. There is no TC/26 modifier required, that I know of.

Also, this code is showing up on non-covered LCDs because it's a category III code - used for tracking and is more of an administrative period than actual medical necessity issue. In 2018 it will transition to a new category I code - used to denote standard of care. Hopefully there will be coverage then too. Still, docs need to prove that medical necessity and describe that Space OAR product in their documentation.
 
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