CRNA billing ultrasound guidance

[missyah20]

I have a case where the CRNA inserted a femoral block under ultrasound guidance for post-op pain. Railroad Medicare is denying the ultrasound guidance stating that our provider can not provide this service. Medicare does pay for the 76942-26. They told us we need to find documentation from Medicare to support that this code is payable to a CRNA. Does anyone know if and where I can find documentation on the CMS website?

Thanks!

 

[jdrueppel]

Missyah20,

I had the same issue, however, it was not RRMC it was regular Medicare. They denied as PR-204 (Yes! pt responsibility). I was told the same thing - not payable when performed by this specialty. I turned it around on the Medicare carrier and ASKED THEM TO SHOW ME the CMS guideline that states this is NOT payable when performed by CRNA as my provider was practicing within the scope of his/her state licensure and hospital privileges. Of course, I was given a call reference number & waiting for them to call back with the guideline when 20 days later Medicare payment arrived

I haven't had the opportunity to bill another to MC (or RRMC) but you can bet I kept a copy of the EOMB in case I need to fight again.

Hope this helps.

Julie, CPC