Wiki CPT 17360 - How and who can bill for this codes?

[Metroderm]

I only know that part that CPT 17360 is consider cosmetic. Can Aesthetician perform and bill to insurance?
I can not find medical policy from the payors website at all, but I heard that some Aesthetician bill this code. I would like to know how it works.
I'm in NY and Healthfirst, Health Plus and UHC Empire plan pays this code if I bill under the MD, and I would like to know if I'm using this codes correctly.
Thank you.

 

[CBLENNIE]

In general insurance companies are not going to credential and/or contract with an aesthetician as they are not typically considered qualified healthcare providers. I don't believe that an aesthetician can obtain an NPI # and there is no taxonomy # for the specialty of aesthetician. The insurance company I work for would not cover services billed by an aesthetician.

If we received a claim billed under the dermatologist but the medical records show the aesthetician performed the services, we will deny the claim. This will likely lead to the provider being put on an audit list, possibly pre-pay which would require all claims to be reviewed prior to payment being release. Or a post-pay audit which would lead to could lead to a demand letter requesting a refund of any claims paid in error and if the refund is not received in a timely manner, we would just withhold the money owed from future payments to the provider. Either of these audit types are like to have a seriously negative impact on your revenue cycle, which could create a cash crunch depending on how many of your claims are submitted to our insurance company. We are also likely to share with other local payers and government agencies what we've found, and it could lead to you being audited by multiple payers.

Does Healthfirst, Health Plus and UHC Empire have written policies that state services performed by the aesthetician can be submitted to them for medical benefit coverage under the MD? If not have you verified wiht them that this is allow and if so do you have it in writing? This billing practice is outside the norm in most states so it maybe something unique to NY and you don't need documentation that this allowed. My philosophy is if you are doing something that is outside the norms in the health insurance industry it is best to CYA and get it in writing from any of the payers you work with that allow this billing practice.

 

[Metroderm]

We have a MD who love to order Chemical Exfoliation for her patient and she bills with CPT 17360. Now she's encouraging other providers to use this code for Acne patients. I need official document from the payor from the medical policy to fight(?) against her. The Healthfirst does NOT have any policy for this specific code, so it will pay as long as it's medically necessary. I can't find any good description of this code saying that this is not for medical providers.

 

[CBLENNIE]

Medical providers, such as physicians, PAs and NPs can bill this service, why do you believe that it is not billable for these types of providers? If the documentation for each session supports the medical necessity and that it is not being performed for cosmetic purposes, then it should be OK for her to bill this service.