HCPCS Bone Allograft

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I need to know the correct HCPCS code a hospital would use to bill for a structural bone allograft - not morselized, a solid piece of bone. I believe C9359 is for the injectable putty & C9362 is for the moldable putty, but what do you use for a structural bone allograft? I thought about C1762, but would bone be considered connective tissue??? I've also thought about L8699 but I wouldn't consider this a "prosthetic" implant - it's a human bone graft. ??? I have searched everywhere & cannot find any guidance on this issue. Please help!!:confused:
 

jennburgel

Networker
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36
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Williamstown, New Jersey
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we bill the c1762 as the implant code at the ASC facility level in order to be paid for the implant itself. n I would assume you could bill for both the procedure and the implant. We are billing as a proc for a knee and we have contracts with the payers that pay the implants as 50% of charges.
 
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Aberdeen Proving Ground, MD
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we bill the c1762 as the implant code at the ASC facility level in order to be paid for the implant itself. n I would assume you could bill for both the procedure and the implant. We are billing as a proc for a knee and we have contracts with the payers that pay the implants as 50% of charges.
jennburgel....Are you being reimbursed for the C1762 when it's billed by an ASC facility???

How are you getting reimbursement when the code has an ASC payment indicator of N1 for packaged service/item; no separate payment made?
 

Ydalis01

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Clifton, NJ
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jennburgel....Are you being reimbursed for the C1762 when it's billed by an ASC facility???

How are you getting reimbursement when the code has an ASC payment indicator of N1 for packaged service/item; no separate payment made?



C1762 has a ASC payment indicator of N1 but this only applies to Medicare. Depending on your ASC contracts, Commercial payers reimburse seperately for implants. At my location, there is a seperate carve out for implants indicated under contract and we are reimbursed at 100% of invoice cost as long as the implant cost is over the threshold amount. The threshold amount varies. (Please note. This only applies for commercial payers) We do not bill Medicare for packaged items.
 

ashlyn26

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Wylie, TX
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Does anybody have any insight into C1762 being billed in the professional setting in conjunction with an LESI and SI joint injections? I have found quite a bit of information about this code being billed in OPPS setting, but not at the professional level.
 

gabreyes87

Contributor
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11
Location
Long beach, CA
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I need to know the correct HCPCS code a hospital would use to bill for a structural bone allograft - not morselized, a solid piece of bone. I believe C9359 is for the injectable putty & C9362 is for the moldable putty, but what do you use for a structural bone allograft? I thought about C1762, but would bone be considered connective tissue??? I've also thought about L8699 but I wouldn't consider this a "prosthetic" implant - it's a human bone graft. ??? I have searched everywhere & cannot find any guidance on this issue. Please help!!:confused:
Maybe 21299 unlisted comparative cpt 20930. Is it for alveolar
 
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