Wiki non-facility NA indicator

[pochranek]

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.

 

[SharonCollachi]

Well, if the fee schedule says zero, then that's what you would get paid... zero.

Seriously, I'm not understanding what is being questioned. The NA status is for "rarely or never" performed in a non-fac setting (such as a code for a hospital encounter). So it's not necessarily inappropriate, it is "rarely or never". So you actually have some standing under the "rarely" term, unless Aetna has a policy that procedures that are marked NA are definitely never covered in the office.