J1030 & j1040

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144
Best answers
0
Hello,
I received two denials for different patients (same insurance). One is J1030 and the other is J1040. The reason says: "Procedure considered part of basic service performed/incidental or bundeled". One of my coworkers called for one of them and the representatives I guess said that the code isn't a Medicare approved code and it's a non covered benefit?? I'm most likely going to have to call, I'm sure, but if this is true... this is news to me. Has anyone else heard this??? Or can anyone give me their thoughts???


thank you
 

jshore

Contributor
Messages
10
Location
Saint Clair Shores, MI
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0
Hello,
I code for an ASC and these codes are never billed separately to Medicare or any private/commercial insurance. Both of these codes have a payment indicator of N1 meaning these are packaged service/item; no separate payment made. Check your Medicare fee schedule, the payment indicator should be listed with each code.

Hope this helps!
 
Last edited:

ollielooya

True Blue
Messages
899
Location
Everett, WA
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0
more details????

Hmmmm, NSG has paid for this code in the past for us. Work for a rheumatology specialist and we've had no problem with Medicare or other carriers paying for the use of these codes. Haven't had to use a modifier either. Unless something has recently changed for these codes, not sure why you're having problems with payment.
 
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