Wiki Is there a CPT code(s) for non billable surgical services (multifocal cataract IOLs, laser cataract surgery, etc.).

[stacey65@optonline.net]

I work for a cataract surgeon who offers add on packages not covered by insurance ( Toric IOLs, laser cataract removal, etc). Some commercial pay patients ask us to submit the non billable services to their insurance so the denial can be shown on the EOB. Is this practice acceptable to insurance companies and if so, what non billable codes are recommended in such situations? Many thanks! Stacey K.

 

[thomas7331]

There is a HCPCS code A9270 with the description 'non-covered item or service', but I've always hesitated to use that code and consider it risky because it requires you to make the assumption that you know in advance whether or not it is actually covered by the payer. I think it is safer to code correctly and to let the payer make the coverage decision for themselves. So if there is no specific code for the service or item, I would recommend using an unlisted code and providing the description so that the payer knows exactly what it is that you are billing for.

 

[narredondo1103@gmail.com]

We would use V2787 or V2788 depending on the lens. We didn't bill these out either. However, the patient ALWAYS signed the ABN or similar liability weaver prior to receiving the upgraded lens. We did run into an issue when we were asked to bill out the extra. The insurance came back with and EOB stating patient was not responsible. We had to fight this. The patient wanted their money back!

 

[Pyralis26]

We are running into the same issue with this code in our practice. However we are dealing with a commercial insurance, not medicare. Who does the billing for this: Facility or the provider?