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Medicare - Pain Management Reimbursement

  1. #1
    Question Medicare - Pain Management Reimbursement
    Medical Coding Books
    Good Morning All!

    I am taking over billing in my ASC from an outside billing company and need some help.

    I have been tasked with finding documentation to prove how many levels of pain management injections Medicare will pay for in a single visit to our ASC.

    I have been told 1 and also 2.

    Please Help!

  2. #2
    Without the specific CPT it is hard to say.
    Kelly A Mcfadyen, CPC

  3. #3
    Example: MD performs CPT's 64493, 64494, 64495 bilaterally.

    How many levels will be paid?

    I also have been explaining that the N1 status codes are not paid by Medicare with no luck. If anyone has documentation for this it would be greatly appreciated.

    Thank you for The Help!!

  4. Default
    Our MAC (NGS) has an LCD for Pain Management - maybe your MAC does, too? It spells out what is covered and how often.
    CMS has articles re: ASC payment indicators and their meanings. If you have time to dig for the actual documentation, you can start with CMS and they will often cite the Federal Register or lead you to where in the Federal Register the indicators are defined. Hope this helps.

  5. #5
    Thank you so much for the Help!!

    I will start my dig on the CMS Site!

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