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01996 maximum days

  1. #1
    Default 01996 maximum days
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    Hi, do you know what's the cap out days for code 01996 and where I can find this info.?


  2. #2

    I have not recently seen a "cap out" for the 01996. Years ago, with a previous Medicare carrier, I remember reading a Provider Notice stating 01996 services after the 7th day postop would be pended for medical necessity but I have never received a request for medical rationale.

    I also checked the CMS Manual and my major carrier's policies (BCBS of Nebraska and UHC) and found no formal policies regarding this issue. I will say, however, the ASA code 01996 IS INCLUDED in my Medicare carrier's (WPS) Epidural Steroid LCD that requires a covered diagnosis as outlined in the LCD.

    That being said, I have billed 01996 for up to 10 (maybe even 11) days (we cover a Level 1 Trauma Center) and have not had any non-payment issues.

    Julie, CPC

  3. #3
    I was researching on CMS & Internet too but couldn't find any rules regarding 01996 maximum billing days, we have had cases with more than 10 days also but I'm not sure if we have had any payment issues (hope not) Thank you so much for your reply and for sharing your experience with billing situations,

    Happy Monday!!

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