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Thread: Code 0232T

  1. #1

    Default Code 0232T

    This is a new code for medicare 0232T which is a Plasma rich protien injection Insurances will not pay for this code. Any feedback how receive payment for the work the physicians are performing

  2. Default Payment?

    We had the same problem in our office when the code first came out. We've been working with another billing company, and now that the code is officially in the book we sent a copy of the page showing the code along with the claim and medical notes. We have not heard back yet, so we're keeping our fingers crossed. However, I know from past experience when it was a variety of codes instead of this one encompassing code that insurances would deny as experimental. From what I understood on that, if it is deemed experimental, there is little hope of ever receiving reimbursement from insurance. If that is the case, you need to make sure you have a waiver on file signed by the patient at time of service that they understand insurance may not cover. I hope this helps!

  3. #3
    Location
    Columbus, OH
    Posts
    76

    Default

    Every insurance I've researched considers PRP (0232T) experimental and does not reimburse. You should get an ABN from the patient so you can bill them after the denial.
    Kathy Daniel, CPC, COSC

  4. #4

    Default 0232t charge

    Can someone tell me what would be a reasonable charge for this procedure? Thx

  5. #5
    Location
    Charleston, South Carolina
    Posts
    640

    Default

    I doubt anyone on this forum will answer your question. Asking for fee related information is a big no-no!! This can get into price-fixing, anti-trust laws, etc. If you are trying to figure out a fee, you may want to look at the RVU schedule, pick a procedure you feel is similar in work, practice expense and malpractice expense, and take the allowable as your fee.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  6. #6
    Location
    Jacksonville Beach, FL
    Posts
    71

    Default

    You can look on the clinical policies for the insurance companies you are contracted with to find coverage details. Some may cover it with some diagnosis and/or place of service and others may deny it all together.
    AWest

  7. #7
    Location
    Charleston, South Carolina
    Posts
    640

    Default

    I've done extensive research into the use of PRP injections. I can tell you that there are some carriers that will cover it. I won't give those thay I know of, as it could be a regional thing, and not necessarily nationwide. Review the coverage policies of your major carriers is my suggestion.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  8. Default Code 0232T (Medicare)

    Do you have to bill Medicare first before collecting money for this procedure, since we already know that it is a non covered service? We do get a wavier signed.
    Does Medicare even have to be billed?

    Missy

  9. Default Cpc

    I have the same question. We make a pt aware that insurance will not cover the injs, have them sign an abn, and then some pts pay that same day or some wait until they receive a bill. I am not sure how we should be going about this should we be waiting until we try to bill their insurance and receive a denial?
    Amanda

  10. #10

    Default

    We collect in full at time of service as the only insurance we deal with that will pay for PRP is work comp.
    With work comp we get pre-auth for the amount we bill.
    Our companies bill anywhere from$750.00-1500.00
    Kelly A Mcfadyen, CPC

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