G0277 and 99183

[TamaraVash]

Hi everyone,
Can you please help me with CPT codes G0277 and 99183? Can a Dermatology practice
ce bill these codes? If yes, what are the rules or billing guidelines for them?

 

[sls314]

Hi everyone,
Can you please help me with CPT codes G0277 and 99183? Can a Dermatology practice
ce bill these codes? If yes, what are the rules or billing guidelines for them?

A good place to start would be to look at the Medicare and other commercial payer policies for Hyperbaric Oxygen Therapy.

If you're working for a practice that is considering offering HBOT, it will be helpful to know whether or not your common payers would pay for the service for the proposed indications in your setting.

Here are a few payer policies and guidelines to get you started:

UHC Commercial: https://www.uhcprovider.com/content...al-drug/hyperbaric-topical-oxygen-therapy.pdf

Anthem: https://www.anthem.com/medpolicies/abc/active/gl_pw_d083866.html
Aetna: https://www.aetna.com/cpb/medical/data/100_199/0172.html

You can search for any NCD or LCD for Hyperbaric Oxygen on the CMS MCD database at this link: https://www.cms.gov/medicare-coverage-database/search.aspx

If there are any other big payers in your area not linked above, you can go to the payer website and search for that payer's policy on Hyperbaric Oxygen Therapy

 

[TamaraVash]

Can I bill both codes together(G0277 and 99183) if the procedure was done in the office?

 

[SheriFaganCPC]

We bill 99183 and G0277 with POS 11 (Office) for our HBOT services. G0277 is paying, however HealthSpring Preferred HMO (Cigna) is denying 99183 with the denial:

"Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service."

I contacted Cigna and was advised that they follow Medicare guidelines. I reviewed CMS NCD 20.29 (Hyperbaric Oxygen Therapy) and was unable to locate any language stating that POS 11 is not an appropriate place of service for CPT 99183. CMS defines 99183 as physician attendance and supervision of hyperbaric oxygen therapy, but I have not found a POS restriction in the NCD.

We are located in Corpus Christi, TX (Novitas JH region). Has anyone else experienced denials of 99183 billed with POS 11 from Cigna/HealthSpring? If so, were you able to identify a specific CMS, MAC, or payer policy supporting the denial, or was it a payer-specific edit? Any insight would be appreciated.