Wiki C9781- Can physicians use or only facilities

[butterflyed]

We see that a new C-code has been added into HCPCS for Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g., limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed using the balloon inspace. Is reporting the C- codes only for facility reporting and physicians still need to use the unlisted code for this or can both facility and provider bill out using those HCPCS codes?
Thank you in advance
Stacey D

 

[thomas7331]

HCPCS ‘C’ codes are only for facility use; they are not part of the physician fee schedule and will be rejected if billed on a CMS-1500 professional claim.

 

[butterflyed]

Thank you for that confirmation. I just needed another opinion to stop 2nd guessing myself

 

[ehleahey]

Are you using an unlisted code for the physicians charges

 

[SHoltzenCPC]

What CPT are people using for a comparison when billing the unlisted code?

 

[Sandy H]

Is anyone getting paid from Medicare for this?

 

[csavitz]

We are wondering the same thing. When I contacted Novitas they said this HCPCS code is not in their system. I tried contacting someone at CMS to find out how to get paid for this, but was not able to reach anyone. Shouldn't this be in Novitas' system if it's been approved by Medicare? Any guidance would be great. We are a facility. Thanks!

 

[Billingandcoding2]

Is anyone getting any traction here with their Medicare MAC? Noridian just denies that the description I am using is not valid. They have a list of descriptions they will accept, and none include subacromial spacer. Since they deny as unprocessable their is no dispute option.

 

[daniel]

Personally, I would compare the 29999 to 29826 for access into and work in the subacromial space for placement of the balloon.