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CPT codes with Place of Service limitation/exceptions

  1. #1
    Default CPT codes with Place of Service limitation/exceptions
    Medical Coding Books
    Does Medicare have a list of CPT/HCPCS codes that are limited to certain places of service?

    We had 38221 and G0364 deny for place of service.

    Thanks!

  2. Default
    I always have to change my place of service to 11 (we bill everyone else as a 07)

  3. #3
    Default
    Thank you for your response!

    Does anyone else know of a Medicare resource as described in my first message?

  4. #4
    Location
    Baton Rouge
    Posts
    1,241
    Default
    Quote Originally Posted by bbooks View Post
    Thank you for your response!

    Does anyone else know of a Medicare resource as described in my first message?
    CMS does have an "inpatient only" list of codes. Go to this link, click on the zip file, agree to terms, and open Addendum E

    http://www.aq-iq.com/cms-inpatient-only-list-cy2014/

    HTH!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  5. #5
    Default
    Thanks, Megan! That appears to be what I need. Curiously, neither of those codes appear on the list. Our pathologist did do the procedure inpatient, though, so I have changed the POS to that. We've just never had it deny for POS in the past.

  6. #6
    Default
    Does anyone know of a comprehensive list?

    We have practitioners who visit patients in Independent Living Facilities, which are considered to be POS "home," and just got a denial for a minor surgical procedure that would be allowed in the office. So we need a list of procedures that are permitted in an office setting, but not in a patient's home.

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