BILLING A4556 with 93000 and billing 99393 with 99213,99401 cpt codes

Procedure code and Description

A4556 Electrodes (e.g., Apnea monitor), per pair

Can physician bill CPT 99285 and CPT 93042?

Ans : Yes you can.

Note : CPT codes describe what services have been performed. The Evaluation and Management (E/M) codes 99281-99285 are the codes for cognitive services most commonly utilized by and familiar to emergency physicians.


Can ASC use outside labs for waive test

Ans : No we can’t. If we billed it won’t be paid.


Can i bill A4556 with 93000?


Ans : We can’t.

Note :  Because A4556 included with CPT 93000. It will not reimburse separately it will be denied as Bundled or inclusive.


Can we bill 99393 with 99213 and 99401 and 99420

Ans : We can bill together, but we would get reimbursement for any one CPT.




Updates to Claims Processing Edits and Reimbursement Policies

Bundled Services and Supplies

As we advised in the July 2014 Network Update, we are continuing to review and add HCPCS Level II temporary “S” codes to the always bundled services edit in ClaimsXten. Unless there are specific, specialized contracts or criteria for a provider to report their services using a HCPCS Level II temporary “S” code, Anthem will consider “S” codes to be always bundled codes. Therefore, effective with dates of service on or after March 1, 2015, these additional “S” codes S0201, S0209, S0215, S0265, S0320, S0390, S0618, S3650, S4026, S8185, S9001, S9025, S9447, S9982, and S9991 will not be eligible for reimbursement as described in Section 1 of the Bundled Services and Supplies policy.

Additionally, as HCPCS Level II codes A4556 – (electrodes) and A4557 – (lead wires) are included in A4595 – (electrical stimulator supplies), effective with dates of service on or after March 1, 2015, codes A4556 and A4557 will not be separately reimbursed on the same date of service and/or within 30 days of code A4595. [Please refer to reimbursement policy: Bundled Services and Supplies


Frequency Editing

The Frequency Editing Policy will be updated effective for dates of service on or after March 1, 2015 to add a limit of 2 pair per 30 days for HCPCS Level II codes A4556 – (electrodes), and a limit of 4 pairs per 365 days for A4557 – (lead wires).


RESPONDENT’S POSITION SUMMARY

Respondent’s Position Summary: “CPT 95911 01/05/2015 – Provider billed $355.59 the provider was paid $355.59 as noted under ICN 26150121557300 on 01/22/2015 check # 240437426…CPT A4556 01/05/2015 – Provider billed $25.00 the provider was paid $0.00. Supplies to perform the billed diagnostic studies are not separately reimbursed. A4556 is included in the payment for 95886 & 95911.”



Issues

1. Is the requestor entitled to additional reimbursement for CPT code 95911?

2. Is the benefit for HCPCS code A4556 included in the benefit of another service billed on the disputed date? Is
the requestor entitled to reimbursement for HCPCS code A4556?

2. According to the explanation of benefits, the respondent paid $0.00 for HCPCS code A4556 based upon reason code “V163.”

HCPCS Code A4556 is defined as “Electrodes (e.g., apnea monitor), per pair.” Per Medicare guidelines, Transmittal B-03-020, effective February 28, 2003 if Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) HCPCS codes are incidental to the physician service, it is not separately payable. A review of the submitted documentation does not support a separate service to support billing HCPCS code A4556. As a result, additional reimbursement is not recommended.


NMES and TENS Supplies

Supply codes A4556, A4557, or A4595 may be reimbursed with documentation of a client-owned device and without prior authorization. Additional documentation such as the purchase date, serial number, and purchasing entity of the device may be required.

Supplies for purchased devices are limited as follows:

• If additional electrodes are required, procedure code A4556 may be considered for reimbursement at a maximum of 15 per month.

• If additional lead wires are required, procedure code A4557 may be considered for reimbursement at a maximum of 2 per month.

• Procedure code A4595 is limited to 1 per month. Supplies are included in the rental and will not be reimbursed separately.



All supplies (lead wires, electrodes, paste or gel, batteries, battery chargers, pouches, and carryingcases) are considered content of purchase of new codes E0720 and E0730. Lead wire, electrodes, and paste or gel may not be billed separately for the first 30 days after purchase of a TENS unit. Code A4556 is limited to no more than one pair (one unit equals one pair) every six months for a two-lead unit. If using a four-lead unit, two pairs are allowed every six months. Code A4557 is limited to no more than one pair (one unit equals one pair) every 12 months for a two-lead unit. If using a four-lead unit, two pairs are allowed every 12 months. Code A4558 is limited to no more than one unit (one ounce equals one unit) every six months for a two-lead unit. If using a four-lead unit, two units (one ounce equals one unit) are allowed every six months. The type of electrodes currently being used must require the use of paste or gel.

1 comment:

Anonymous said...

Can I bill any of the following A6411, a4558,a4556 with the cpt codes of 95950 and/or 92275?

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