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Does SNF have pmt responsibility for 99152?

  1. #1
    Default Does SNF have pmt responsibility for 99152?
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    Dr did Kyphoplasty on SNF patient in the Office Setting.
    99152/99153 were moderate sedation codes billed along with the 22513 for kyphoplasty. Medicare paid 22513...Denied 99152/99153 stating it is responsibilit of SNF.
    For non-SNF patients, Medicare does pay 99152/99153.
    Does anybody have any documentation stating that 99152/99153 pmt is the responsibility of the SNF?

    Thx
    Ken Lobo

  2. #2
    Default
    Medical Billing
    99152 is on the list of codes not part of consolidated billing. 99153 is under SNF consolidated billing since its considered a technical only component code.

    https://www.cms.gov/Medicare/Billing...AC-Update.html
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

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