Wiki Office Setting Procedure

Create Wiki
J

jnemunoz

New
Messages
2
Location
Corona, CA
Best answers
0
How can you tell if you can have certain procedure done in the office setting versus facility? Does anyone have resources or can direct me to a list of approved surgeries that can be done in an office setting? We have denials where CPT code 69631 and 69450 were denied as not covered when rendered in the office and can only be done in facility setting. Thank you!
 
The insurance is the best resource. And keep in mind that just because one insurance may allow it does not mean that all will. I think this is something that should be addressed during the pre-auth process letting them know that you intend on performing the service in the office.
 
I usually start with the Medicare Fee Schedule Lookup tool. In your case, the results show there is no non-facility pricing:

1620165187806.png
 
You must log in or register to reply here.
Top