# +19295



## ShellySerigne09

Have trouble with add on code 19295 my physician places metallic clip when doing breast bx just recently medicare and uhc will not pay medicare states invaild pos and uhc states included with primary proce ???   Has always been paid before anyone have any suggestions  thanks


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## DFlemings

*Clip*

Is add-on code being used with  CPT 10022,  19102,  or 19103  Primary Procedures?


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## kerileigh

also having this same problem... using 19295 with 19103 and the 19295 is being denied for POS can not be done in an outpatient setting for medicare


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## tgately

*clip*

we are also having this same problem. Our physicians are doing the biopsy and placement of the clip. Has anyone been able to get a response on how to get this paid. please post. thank you.


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## tgately

*clip*

we are also having this same problem. Our physicians are doing the biopsy and placement of the clip. Has anyone been able to get a response on how to get this paid.


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## mkmgt001

I just noticed that the NPFS PC/TC indicator for CPT 19295 changed from "0" in 2012 to "3" in 2013.  I suspect this is why CPT 19295 is no longer getting paid in a facility setting. "0" means "Physican service codes. Modifiers -26 & -TC cannot be used.".  "3" means "Technical component only.  Modifiers -26 & -TC cannot be used.  No payment can be made for inpatients or outpatients.".  I don't understand why CMS changed the indicator, but that would explain the denial. 

Mary Kittredge, CPC


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## tsbowers22

*19295 Denials for POS 22*

We have noticed the same denials from UHC and Humana.  So far Medicare has paid our 2013 claims but we are expecting recoups.  We found a webpage that explained this.  Go to http://www.medicarenhic.com and go to the Part B provider issues link.


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## mkmgt001

Thank you for the additional information & link!  

FYI: After clicking on the link & chosing the Part B Home Page, I couldn't find the "provider issues link", so I just typed "19295" in the search box & it brought me to the topic under "Part B Open Issues".


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## monger

I spoke with Medicare regarding this and was told effective 1/1/13 this is only covered under Part A although no information had been sent out yet.  Go figure!


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## MCCONKEYT

*I talked to Novitas re same problem*

I have posted this on another thread.  The rep told me there is nothing out there "written" about it and the only way they figured it out was to do a Fee Schedule Search for 2013 & 2012.  Then compare PC /TC indicators for each year.  mkmgt001 is right.  
3 is technical component only.  The rep told me that the Physician could bill the hospital, and then the hospital reimburse the physician.  What a hassle.

I have my documents saved and would be glad to share.  
terim3006@centurylink.net


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## mkmgt001

Thank you for the additional information mcconkeyt.


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