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billing Medicaid - I have a scenerio

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    Medical Coding Books
    Quote Originally Posted by FasTrack View Post
    we learned from a drug rep that SC medicaid will pay for "sounding" of the uterus(57800) and surgical tray(a4550) as well as insertion(58300), product(j7300 or j7302) and a pregnancy test(81025) if patient is menstrating at the time of her appointment. Sorry I don't have any specifics on Medicare/Medicaid. We bill all 5 codes for all insurance companies but often have to w/o 57800 for some of the commercial insurance companies.
    I was just wondering can anyone please point me in the direction of these type of codes (a4550). We never before billed for it and I was wondering where can I find a discription of what exactly is this code (besides "surgical tray) and I am sure there is some sort of a book that I don't know of.


  2. #12
    the procd codes will be find in the cpt book (insertion & removal 58300 & 58301 using diag v25.1 & removal v25.42), also contact the medical supplier tht provide the iud ie Mirena which they have a website with all the info related to their product

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    is your patient on family planning take charge program? We are able to get medicaid to pay on the J7302 and the 58300, but have had a patient that was take charge only and we got the denial of we are not authorized to do this service. We are with medicaid, we are not registered with the Take Charge program, which is done separately. Trina

  4. #14
    Smile Bonny
    In WA state, we are not contracted to accept Take Charge so if that's the patien'ts plan, we refer them to Family Planning. If they hae any other Medicaid coupon we get reimbursed for the insertion, 58300, the method, J7300 or J7302, a pregnancy test, 81025 and and E&M code, if approp. with modifier 25. They will not pay the surgical tray & I've never tried the uterine sound code.
    One reason you may not be reimbursed is based on your provider type and yur Core Provider Agreement with Medicaid. Check with your provider rep about that. Also, I've had private payers try to deny the IUD as they only cover prescription dispensed at the pharmacy. I have won every appeal based on this method can only be inserted by the provider and not by a pharmacy.

    Good luck!

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