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Refilling of implantable pump(95990)

  1. #1
    Question Refilling of implantable pump(95990)
    Exam Training Packages
    Does anyone have any information on this code? My provider is billing for this code with a POS 22. Medicare has denied stating "Treatment was deemed by payer to have been rendered in an inappropriate or invalid POS." Does anyone have a link to any Medicare guidelines or informaiton for this code? Thank in advance!
    Missy Heuer CPC, CIRCC, CANPC

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    95990 is administered by a professional who is not a physician. CPT code 95991 is performed by a physician. Could this be the issue? The POS shouldn't be an issue. This service can be performed outpatient per the CMS hospital list.

    I'm not sure which region you're in but I have attached one Medicare link.

    https://www.noridianmedicare.com/sha...ble_Device.htm

    http://www.medtronic.com/neuroreimbu...CBCPhy4-08.pdf
    Last edited by RebeccaWoodward*; 01-21-2009 at 09:02 AM.

  3. #3
    Default
    OK, so that is probably the problem I am having. This is being performed by an MDA. So I should be using 95991, right? I just want to be sure. Thanks for your help!
    Missy Heuer CPC, CIRCC, CANPC

  4. #4
    Question Medicare payment for 95990?
    We recently had a denial for a nurse practitioner who performed a pump refill. We used 95990 which looks like the correct code but Medicare denied it saying it was not a covered code? Any ideas?

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