Wiki HCPCS G0463 question re commercial insurance

[debellis59]

Hi Everyone: At the hospital system where I work, some (not all) of our clinics bill for HCPCS G0463. We do this with Medicare, Medicare Advantage, and Medicaid. That's it.

One of my coworker's sister just got a bill for G0463 being applied to their deductible by their commercial insurance (hospital/clinic system 200 miles from our system) although the ProFee side was paid. I wasn't aware of commercial insurance companies accepting this code. The visit was for a 7 yo boy to see his ENT. Is it now appropriate to bill a commercial plan for this code? And if not/or even if so, where do I find specific documentation in re to commercial insurance. All I can find is how it pertains to Medicare and Medicaid.

Your help is appreciated.

Thank you.

Deb

 

[thomas7331]

A commercial insurance company's coding and billing requirements would be documented in their published policies or in the terms of the provider's contract with that particular payer. Those would be the only places you could go to find the answer to your question as there aren't any general coding guidelines that apply equally to all commercial payers.

Given that in this instance the payer has accepted and processed the charges, it would appear that they do allow that code to be billed - otherwise they would have rejected it back to the provider as an invalid claim.

 

[debellis59]

A commercial insurance company's coding and billing requirements would be documented in their published policies or in the terms of the provider's contract with that particular payer. Those would be the only places you could go to find the answer to your question as there aren't any general coding guidelines that apply equally to all commercial payers.

Given that in this instance the payer has accepted and processed the charges, it would appear that they do allow that code to be billed - otherwise they would have rejected it back to the provider as an invalid claim.

Thank you.