Wiki Code 0232T

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djohns

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This is a new code for medicare 0232T which is a Plasma rich protien injection Insurances will not pay for this code. Any feedback how receive payment for the work the physicians are performing
 
Payment?

We had the same problem in our office when the code first came out. We've been working with another billing company, and now that the code is officially in the book we sent a copy of the page showing the code along with the claim and medical notes. We have not heard back yet, so we're keeping our fingers crossed. However, I know from past experience when it was a variety of codes instead of this one encompassing code that insurances would deny as experimental. From what I understood on that, if it is deemed experimental, there is little hope of ever receiving reimbursement from insurance. If that is the case, you need to make sure you have a waiver on file signed by the patient at time of service that they understand insurance may not cover. I hope this helps!
 
Every insurance I've researched considers PRP (0232T) experimental and does not reimburse. You should get an ABN from the patient so you can bill them after the denial.
 
0232t charge

Can someone tell me what would be a reasonable charge for this procedure? Thx
 
I doubt anyone on this forum will answer your question. Asking for fee related information is a big no-no!! This can get into price-fixing, anti-trust laws, etc. If you are trying to figure out a fee, you may want to look at the RVU schedule, pick a procedure you feel is similar in work, practice expense and malpractice expense, and take the allowable as your fee.
 
You can look on the clinical policies for the insurance companies you are contracted with to find coverage details. Some may cover it with some diagnosis and/or place of service and others may deny it all together.
 
I've done extensive research into the use of PRP injections. I can tell you that there are some carriers that will cover it. I won't give those thay I know of, as it could be a regional thing, and not necessarily nationwide. Review the coverage policies of your major carriers is my suggestion.
 
Code 0232T (Medicare)

Do you have to bill Medicare first before collecting money for this procedure, since we already know that it is a non covered service? We do get a wavier signed.
Does Medicare even have to be billed?

Missy
 
Cpc

I have the same question. We make a pt aware that insurance will not cover the injs, have them sign an abn, and then some pts pay that same day or some wait until they receive a bill. I am not sure how we should be going about this should we be waiting until we try to bill their insurance and receive a denial?
Amanda
 
We collect in full at time of service as the only insurance we deal with that will pay for PRP is work comp.
With work comp we get pre-auth for the amount we bill.
Our companies bill anywhere from$750.00-1500.00
 
Insurance Coordinator

I am interested in the billing for PRP injections (0232T). I have been reading your prior posts. We billed the service with an office visit and when the insurance reviewed the claim they upped the value of the E&M stating the procedure would be mutually exclusive. The EOB didn't even list the procedure, leading me to believe they don't recognize the code. We did have the patient sign responsibility but can we still hold the patient responsible since the insurance did not deny as a non covered procedure?
 
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