One of our orthopedics does CPT 25000 in the office setting. Aetna has denied the claim stating per CME Physician Fee Schedule codes 25000 have a status indicator of NA in the non-facility field which indicate it is rarely or never performed in the non-facility setting.
I do see the NA indicate in the Medicare Fee for service but it also show a non-fac PE RVU as well as the work RVU.
My question, where can I find documentation from CMS stating the NA indicator states it is inappropriate for this procedure when the place of service is 11 (office).
Thank you for your help!
Peggy O.
I do see the NA indicate in the Medicare Fee for service but it also show a non-fac PE RVU as well as the work RVU.
My question, where can I find documentation from CMS stating the NA indicator states it is inappropriate for this procedure when the place of service is 11 (office).
Thank you for your help!
Peggy O.