Wiki HCPCS Code G0330 Is it used as a professional fee or a facility fee?

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jfolz

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Hi all. TIA for any official sources anyone has and can make available regarding this question.
Is the new HCPCS code G0330 intended to be used for the professional fee or the facility fee?
I code for a facility (hospital outpatient) and we are sending this code for Medicaid dental cases requiring general anesthesia that are done at our center. A billing rep contacted us regarding denials and she said their software has indicated that G0330 is for the professional fees. I have only found online that the intention of the ADA when petitioning Medicaid to create this HCPCS code was to make the distinction between the unlisted 41899 that we used to send and these dental cases that require anesthesia because they were having trouble booking time for at the ASCs. The reimbursement for the unlisted cases were so low, that to maintain profitability, ASCs were denying dentists the facility time they needed to book for those cases. G0330 was created to pay at a higher and more appropriate level and help insure patients and their dentists can access appropriate facilities for service. We don't use many HCPCS codes and I am not sure how to find more information on this topic. At this time we are only sending G0330 for patients covered by Medicaid insurance.
 
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jfolz said:
Hi all. TIA for any official sources anyone has and can make available regarding this question.
Is the new HCPCS code G0330 intended to be used for the professional fee or the facility fee?
I code for a facility (hospital outpatient) and we are sending this code for Medicaid dental cases requiring general anesthesia that are done at our center. A billing rep contacted us regarding denials and she said their software has indicated that G0330 is for the professional fees. I have only found online that the intention of the ADA when petitioning Medicaid to create this HCPCS code was to make the distinction between the unlisted 41899 that we used to send and these dental cases that require anesthesia because they were having trouble booking time for at the ASCs. The reimbursement for the unlisted cases were so low, that to maintain profitability, ASCs were denying dentists the facility time they needed to book for those cases. G0330 was created to pay at a higher and more appropriate level and help insure patients and their dentists can access appropriate facilities for service. We don't use many HCPCS codes and I am not sure how to find more information on this topic. At this time we are only sending G0330 for patients covered by Medicaid insurance.
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The official description of the code says that it is a facility code, so I do agree with you on that.

That being said, Medicaid implementation of codes varies by state, and some states do strange things with their codes. Is this for Indiana? We could check to see how Indiana Medicaid wants that code used.

(An example that I encounter in my daily work life: Ohio Medicaid's physician fee schedule lists 77387 as a physician only code. This means they don't want a 26 modifier with the code - I submit 77387 no modifier to Ohio Medicaid. 77387 is actually a technical only code. Why Ohio Medicaid considers it a physician only code is beyond me, but I don't make the rules - I just follow them.)
 
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