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Thread: Medicare guidelines for in office procedure

  1. #1

    Default Medicare guidelines for in office procedure

    AAPC: Back to School
    Per Medicare guidelines, when an injection procedure is performed in the provider's office is the cost of the injected medication and the marcaine included in the allowance for the injection procedure, such as code 64479? The allowance the provider receives for the in office injection is greater than the reimbursement he/she would receive if performed in an ASC. Is this increase not to cover the injected steriod/anesthesia and the supplies?

  2. #2
    Join Date
    Apr 2007
    Athens, Ga.


    The allowance for in-office procedures is greater because the provider is not getting paid just for his training and expertise, but also to cover the overhead costs of runnining his office. If the procedure was done in an ASC his reimbursement is less because he is just getting paid for his expertise.
    Walker Bachman, CPC, CPPM

  3. #3


    So are the charges for the supplies and medications integral to the procedure allowance??

  4. #4
    Join Date
    Apr 2007
    Athens, Ga.


    Oh sorry... didn't answer that, did I? LOL

    I usually bill all the supplies, but don't fight very hard if they get bundled.
    Walker Bachman, CPC, CPPM

  5. #5
    Join Date
    Apr 2007
    St. Joseph County, Indiana


    Supplies to fight really hard for: Any drugs that start with a "J"
    Supplies to fight sorta hard for: Trays, needles and "extra" supplies
    Supplies not to fight for: locals.

    Brock Berta

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