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Medicare regs for in office procedure

  1. Question Medicare regs for in office procedure
    Exam Training Packages
    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?
    Last edited by cunningham; 02-11-2010 at 11:19 AM.

  2. #2
    Sioux Falls South Dakota
    No, the increase in allowance for doing the procedure in the office has more to do with the practice expense (overhead); rent, employee salaries, etc. You do still charge for the injectible with a J-code for the drug used. However, the Marcaine or Lidocaine is not separately reimburseable by Medicare or most third-party payers - they consider local anesthesia part of the procedure. I hope this helps.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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