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Implants in an ASC

  1. Default Implants in an ASC
    Medical Coding Books
    We are a free standing ASC. Do you bill all implants to all carriers (including Medicare) and then adjust off when denied? Do you use L8699 for all implant billing? Is there a specific modifier? We currently, only bill the insurnace companies that we have specific quidelines for in our contract regarding implants. Where can we find the billing guidelines for this? Thanks for your help!

  2. #2
    Yes you bill implants to Medicare
    Some are covered not many but the patient may have a secondary insurance that will pick it up( it is rare nowadays but it could happen) You would use the denial from Medicare to send to secondary.

  3. #3
    Monmouth, NJ & Dover, DE
    Lori, Here is an article from 05...BUT it has some good info in it. You dont put a modifier on implant codes. L8699 is a very common implant code used in ACSs. {of course if you code breasts its L8600, and neuro implants have a few, one being a electrode L8680}
    Hope this helps.

  4. Default
    Thank You

  5. #5
    Default Implant billing
    Implant billing is a nightmare that is specific to the carriers. Some carriers still want all implants billed as 99070. Most other carriers want HCPCS Level II codes, so get the book and get familiar. These codes change often, so stay up-to-date. Medicare wants a different set of HCPCS Level II codes than commercial carriers. Some CPT codes are 'Device Intensive' for Medicare, so the implants are automatically in the reimbursement and you don't bill for them. Some HCPCS II codes are not reimbursable by Medicare, and billing them is futile. All of this Medicare info is on the CMS website, so dig in and find it.

    Bottom line, look at your contracts, or make phone calls, or bill and wait for the outcomes. Set up a ring binder (or spreadsheet) and when you figure out how to get an implant paid, save the info.

    Richard Mann, your pain management coder

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