Question Claims processor raising edits for professional component claims missing HCPCS for radiopharmaceutical tracer

Messages
4
Best answers
0
Hello, folks.

The claims processor is stating that our professional component claims for PET and PET-CT scans that include the PI modifier must also include HCPCS code A9552. They are citing the Medicare Claims Processing manual sections 60.3.1 and 60.3.2 as well as NCD 220.6.17 as their source for this requirement. From what I can find, A9552 has a status indicator of N and is paid under OPPS.

A9552 is a supply and can only be billed by the facility, correct? Does anyone have any other citations to offer to our claims processor that their position is incorrect?
 

thomas7331

True Blue
Messages
2,965
Best answers
7
I don't have a reference for this but you are correct, the supplies are part of the technical component and billed by the facility or imaging center where the test is performed. This should be self-evident and not something you need to prove to the payer. If the representatives you're speaking with don't have the level of understanding to be able to recognize that this is a claims processor programming error, then I'd recommend you escalate the issue to a supervisor or manager.
 

trarut

Expert
Messages
382
Location
Columbus, OH
Best answers
0
The last office I worked at, we had a Radiology department of our own, including a PET scanner. We billed for the radioisotopes used for our scans - but again, this was global billing under POS 11. For whatever help that is.
 
Top