Wiki 62311

[Marcey28]

Medicare is not paying for CPT 62311 when it is billed with 64493, 64494, 64495 also for the past couple of months they are not covering our drug screens can some one please help

 

[Cassandra Stone]

how are you billing for the drug screens? Where are you located? Is the provider supplying appropriate indications for each of the injections? There are no CCI edits stating those codes can't be billed together, but you should check the LCD.

 

[dwaldman]

You might want to look at the local coverage determination policy for both paravertebral facet injections and urine drug screens to determine specifics in their policy for coverage versus limitations.

For example, in the below LCD from WPS Medicare J5, they do not endorse the performance of a combination of epidurals and facet blocks.

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Accordingly, providing a combination of epidural block, facet joint blocks, bilateral sacroiliac joint injections, lumbar sympathetic blocks or providing more than three levels of facet joint blocks to a patient on the same day is considered not reasonable or necessary. Such therapy can lead to an improper diagnosis or unnecessary treatment.

Indications:
Suspicion of facet joint pain.

Limitations:
Radiculopathy should be ruled out by physical or electrophysiologic examination