Otolaryngology Coding Alert

Question: An in-office procedure required a sterile surgical tray. Is there a billable CPT® code for surgical supplies that we’ll be reimbursed for?

Iowa Subscriber

Answer: Although Medicare does not provide extra reimbursement for a surgical tray that is an integral part of the procedure, some private insurers will. Note that the CPT® code for a surgical tray (99070, Supplies and materials [except spectacles], provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) states that these are for supplies and materials provided by the physician over and above those usually included with the office visit. If your payer accepts 99070, submit it in addition to the code for the procedure itself.

Caveat: Know, however, that you might not get full reimbursement for what your physician pays for the tray. That’s because Medicare and many private payers pay a site of service differential when a procedure is performed in your office. This means that the office fee paid by Medicare and these other private payers for in office procedures are higher than procedures performed in other facilities such as the hospital or an ASC. This differential is considered to be payment for surgical trays and other disposables. Other payers, such as Cigna do not offer a site of service differential and pay the same no matter where a service is provided. They are therefore not paying the practice anything for their surgical trays and disposables within their CPT® fee when they have the same fee in the office and out of the office.