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.
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