Wiki CPT codes 29823 with 29827

[shortee3810]

We recently noticed that insurance (Aetna and UHC) reimbursing only 20% instead of 50% for CPT code debridement code (29823). Is anyone else experiencing this or is it a recent change? We were told it was due to multiple endoscopy procedure reduction.

 

[orthobiller2017]

Uhc has its endo formula available via policy. Depending if self insured vs fully insured the payer can use the endo formula

 

[shortee3810]

So you are saying that they can pay less than the 50%? And is the UHC endoscopy formula available for us to review like on their website? I am a little unclear about your response, so If my questions doesn't make sense I apologize.

 

[orthobiller2017]

Yes. Look under uhc endoscopic multiple procedure reduction policy. Basically you have to take the base code minus it from the rvu of the billed code and divide. They give you an example and u can mimic it. It usually somewhere in neighborhood of 20-30%.

 

[shortee3810]

Ok, thank you for UHC MPPR. Do you know where I can find Aetna MPPR policy? Code 29846 RVU 6.89 allowed amount $723.11
Code 29844 RVU 6.51 allowed amount $691.74
We tried to find the Aetna MPPR policy but was unsuccessful.