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Thread: Donated neurostimulator implant (medicare)

  1. #11
    Join Date
    Apr 2007


    AAPC: Back to School
    as long as the facility purchased it, the reimbursement from Medicare is already calculated in (as per all N1 payment indicators) so you would not use the modifier. However, if you have a case that the rep is giving it to your facility (which they do alot but since you are not back in the OR, you have no way of really knowing), then you would need to use the modifier to let the carrier know "hey we didnt pay for this" so that they can make the appropriate adjustment to the reimbursement.

    hope this helps
    Mary, CPC, CANPC, COSC

  2. #12
    Join Date
    Apr 2007


    Your reimbursement will be reduced if you did not supply the implants. The CMS payment indicator for these is H8 which is device intensive. That means that more than 50% of the cost of the procedure is due to the devices/implants. This is the reason for billing with modifier FB. The contractor will reduce the ASC payment for the procedure by the amount of payment that CMS attributed to the device when the ASC payment rate was calculated.
    Juanita Mendoza, CPC

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