Wiki breast biopsy with clip placement

[bmyers]

We are getting numerous denials starting 01/01/13 when we bill 19103 with clip placement (19295). Has there been a change that I have missed?

 

[bpowell121774]

We too have been receiving denials of the same nature and when we called Medicare they told us that the code had been "re-classified as a Part A reimbursement only code" We were also told that there is a more appropriate code to use but we have had no luck in finding it?? We filed an appeal and asked them to re-look at how they classified this code.

 

[MCCONKEYT]

I called Medicare on this

I called Novitas Solutions who is the MAC carrier for Colorado. I was told that there is nothing written down for this change. The only way they figured it out themselves was to do a CMS fee schedule search for 2013 and code 19295. There is a tool for this on the CMS website. You will see that the that the PC / TC Medicare Physicians Fee Schedule Indicator is "3." Then do another search for 19295 for 2012 and you will see that the Indicator was "0".

0 = Full Service only (Physician Service Codes)

3 = Technical component only codes

19295 is a Part A only code. The Medicare Rep told me that the Physician can bill the hospital, they can bill Part A, and then reimburse the Physician when Part A pays.

Below are the links to help you:
CMS Fee Schedule Tool
http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Medicare Physicians Fee Schedule Indicator Descriptions
https://www.novitas-solutions.com/partb/reimbursement/mfsdbhelp.html

Feel free to contact me terim3006@centurylink.net if you would like copies of what we found.

 

[cherylann.knighton]

breast clip

HI!
Just making sure, does this affect Commerical plans? I called BCBS Federal, and stated it is a covered benefit and also called Aetna with the same answer.
So it would be a payer specific denial? Thanks

 

[hcg]

I called Novitas Solutions who is the MAC carrier for Colorado. I was told that there is nothing written down for this change. The only way they figured it out themselves was to do a CMS fee schedule search for 2013 and code 19295. There is a tool for this on the CMS website. You will see that the that the PC / TC Medicare Physicians Fee Schedule Indicator is "3." Then do another search for 19295 for 2012 and you will see that the Indicator was "0".

0 = Full Service only (Physician Service Codes)

3 = Technical component only codes

19295 is a Part A only code. The Medicare Rep told me that the Physician can bill the hospital, they can bill Part A, and then reimburse the Physician when Part A pays.

Below are the links to help you:
CMS Fee Schedule Tool
http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Medicare Physicians Fee Schedule Indicator Descriptions
https://www.novitas-solutions.com/partb/reimbursement/mfsdbhelp.html

Feel free to contact me terim3006@centurylink.net if you would like copies of what we found.

That is very helpful information. Thank you for sharing. We have the same situation, Medicare paid 19103 & denied 19295 with this reason "Claim not covered by this payer/contractor" I just want to make sure that I find some answers here before calling Medicare.