What is the Medicare denial to CPT 64405-50 modifier?
re: Medicare Denial to CPT® 64405-50 modifier First: you have to check the Medicare Fee Schedule to see if the service is defined as unilateral or bilateral. You only apply modifier 50 to codes that are defined as unilateral.
Does the 150% payment adjustment apply to Medicare Code 64405?
For code 64405, the indicator is "1" bilateral. This means the 150% payment adjustment DOES apply. 100% allowable for first side and 50% allowable for bilateral side. Add modifier -50 to code 64405 (1 unit) (Medicare)
What is the CPT code 64405?
The Current Procedural Terminology (CPT ®) code 64405 as maintained by American Medical Association, is a medical procedural code under the range - Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures on the Somatic Nerves.
What is the difference between procedure 64405 and 20552?
64405 (is a column 2 procedure) when you bill it with 20552 (which is a column 1 procedure) therefore procedure 64405 would need an appropriate modifier to be billed with 20552 for your claim. Good luck resolving your denial; I recognized adjustment code CO236 that is a claim adjustment code.
Does Medicare cover CPT code 64405?
Medicare does not have a National Coverage Determination (NCD) for injection, anesthetic agent, greater occipital nerve (CPT code 64405).
Is 64405 a bilateral procedure?
CPT code 64455 is the appropriate code for reporting nerve block injections for Morton's neuroma. Only one unit of code 64455 should be reported per DOS, per neuroma, regardless of number of sites injected. Code 64455 is a unilateral procedure. For bilateral procedures, modifier 50 should be used.
Does 64450 need a modifier?
CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) has 0 global days so you would report 64450 without a modifier since the global day is 0.
What is procedure code 64405?
Group 1CodeDescription64405INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE64415INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS64416INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)16 more rows
Does 64405 need a modifier?
For example, if the physician administers a greater occipital nerve (GON) block on the left side, you should submit code 64405 (Injection, anesthetic agent; greater occipital nerve) and append modifier LT (Left side).
What is a 50 modifier?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
Is 64450 covered by Medicare?
Medicare no longer allows billing of code 64450 (peripheral nerve block).
How do I bill CPT 64450?
Looking at the lateral branch nerve is a peripheral nerve and would be reported with CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch, when a lateral branch nerve block is performed. Please note: CPT code 64450 should only be reported per nerve or branch and not per injection.
Is 64450 an add on code?
These therapies are not to be coded using CPT code 64450. This code addresses the additional work of an injection of an anesthetic agent(s) (nerve block) and/or steroid by a qualified health care professional within their scope of practice.
How do you bill a ganglion impar block?
Question: What is the appropriate CPT code to report for a ganglion impar sympathetic block? Answer: Code 64999, Unlisted procedure, nervous system, should be reported.
How do you bill Genicular nerve block?
Effective in 2020, there is a CPT code specific to this procedure: Code 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed.
How do you bill a nerve block?
The CPT code set for nerve blocks is 64400-64530 Peripheral nerve blocks-bolus injection or continuous infusion: 64400 Injection, anesthetic agent; trigeminal nerve, any division or branch.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from CMS National Coverage Determination (NCDs) and coverage provisions in interpretive manuals are italicized throughout the Local Coverage Determination (LCD). NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860 [b] and 42 CFR 426 [Subpart D]).
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Peripheral Nerve Blocks. National Coverage Non-coverage for prolotherapy, joint sclerotherapy and ligamentous injections with sclerosing agents is found in CMS Publication 100-03, Medicare National Coverage Determinations Manual, Section 150.7. Effective January 21, 2020, all types of acupuncture including dry needling for any condition other than chronic low back pain are non-covered by Medicare.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
The following billing and coding guidance is to be used with its associated Local Coverage Determination.
ICD-10-CM Codes that Support Medical Necessity
The following list of ICD-10-CM codes support medical necessity for all Group 1 CPT codes listed in this LCD (Somatic & epidural nerve block procedures). These diagnoses must be supported by appropriate documentation of medical necessity in the medical record. These are the only covered diagnosis for Group 1 CPTs:
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33933 Peripheral Nerve Blocks. Please refer to the LCD for reasonable and necessary requirements.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
