We are having a dilemma with one of our payers with regards to codes new to 2017 (CPT 36901-36909). CPT 36907 - 36909 are add-on codes with 36901-36906 the possible primary codes. The problem is that some of the add-on codes have a higher allowable rate and higher RVU value than the primary procedure. Therefore, one of our payers is using this as a reason to pay the add-on code as the primary procedure and reduce the actual primary procedure and citing multiple procedure rule. For example, when billing 36902 and 36908 together they are paying 36908 as primary and reducing 36902 by 50%. I disagree with this. How can an add-on code be considered the primary procedure when by definition it is not? Noridian, our Medicare MAC has been paying them correctly, allowing both codes at 100%. When I pointed this out to our payer, their response was that perhaps Medicare was paying the claims incorrectly and would be recouping the money once they do an audit. Can I please get other's thoughts on this topic?
Thank you!
Gina, CPC
Thank you!
Gina, CPC