Wiki C/S assists 59514 80, AS Do these get reimbursed anymore?

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marytwalsh

marytwalsh

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Hello All
C/S assists 59514 80, AS Do these get reimbursed anymore?
If yes - do you take any steps besides sending the claim ?
All replies we receive now is bundled - $0.00 reimbursement
Please and Thank you
 
Reimbursement is often a payor determination. You would need to check payor policy and/or your contracts (which could differ than mine). 59514-80 and 59514-AS are valid procedure/modifiers and coding them (when performed and documented of course) is not incorrect.
If I had a payor bundle, I would appeal with records that should include why an assist was needed.
 
csperoni said:
Reimbursement is often a payor determination. You would need to check payor policy and/or your contracts (which could differ than mine). 59514-80 and 59514-AS are valid procedure/modifiers and coding them (when performed and documented of course) is not incorrect.
If I had a payor bundle, I would appeal with records that should include why an assist was needed.
Click to expand...
Thank you for your reply - But I am still wondering if you / anyone has received any payments for the assists in 2025 please
 
marytwalsh said:
Hello All
C/S assists 59514 80, AS Do these get reimbursed anymore?
If yes - do you take any steps besides sending the claim ?
All replies we receive now is bundled - $0.00 reimbursement
Please and Thank you
Click to expand...
Mary - Oregon providers are also having the same denials across the commercial payer spectrum. Our office has been appealing the claims, with some success and are currently keeping a log of the payers having difficulty understanding the updated NCCI edits regarding the 80 modifier as it pertains to C/S assist deliveries. As a result, administration will be requesting a contracting carve out to resolve the issue. It's been a frustrating year regarding these denials to say the least. Thanks for putting this out there, I was starting to feel like an island. 🏝️
 
marytwalsh said:
Thank you for your reply - But I am still wondering if you / anyone has received any payments for the assists in 2025 please
Click to expand...
It's typically a fight, but particularly for a complex delivery properly documented, I have seen payments.
 
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