Tennessee Subscriber
Answer: Medicare reimburses practices for unlisted procedures it just takes a bit more effort to submit these claims than those with more specific codes.
These demonstrate to the carrier why you deserve the same amount of reimbursement that the comparable established code commands. In your letter, describe how much time the physician spent performing the procedure, the number of medical personnel required to complete the surgery, and the level of complexity involved.
If you perform this procedure often, you should be proactive and meet with your carrier medical director as well as the medical directors for the non-governmental insurers for which you most frequently provide services. Describe the procedure, arrange for its coverage, and negotiate a mutually agreeable allowable fee in advance. This way, when you submit the unlisted-procedure code with the report and the agreed-upon ICD-9 codes, the claim will not undergo an individual review, but instead will be approved by local policy and will be paid as agreed.