Myringotomy & tubes 69436


Best answers
Can you billed for the tube supply (L8699) with the Myringotomy & tube procedure (69436) or is it considered bundled with the cpt code? I am
facility billing.
I code Amb Surg in a hospital setting
We do not code L8699 for the tubes in addition to the placement of them.

Magnolia...why not? Do your contracts not allow for reimbursement?

I have 1 of my 11 ASC's that has chosen not to bill them because they dont feel the reimbursement is worth it.
As for devices, prosthetics, certain drugs, etc., the HCPCS codes are attached to those charges via Chargemaster.

As for the second part of your question, I can only surmise that reimbursement (or I should say lack there of) is the reason the powers that be have opted not to assign a HCPCS to this charge.
The tympanostomy tubes themselves, as a supply, are not separately reportable as they are considered an integral part of the procedure. The reimbursement is included in the practice expense of the non facility RVU for the tympanostomy tubes. Even if performed in the office.
Myringotomy tubes

2618216km ... You indicated that the tubes were not seperately payable. Where did you find that information. Im getting quite a few in with the L8699. Not sure whether to deny or pay..
PE Tubes

In the ASC setting, OPPS rules include payment for non-passthru items inclusive to the reimbursement for the primary CPT.

Also, if they were separately reportable, it would not be with L8699 "Prosthetic implant, not otherwise specified". The PE tubes do not serve any kind of prosthetic function. Separate reporting could only be limited to HCPCS A4649 "Surgical supply, miscellaneous".