Wiki Medicare Breast Implants

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CMBA4

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Can Someone Please Help! -

I am just beginning in the plastic surgery area - The surgeon is sending out implant fees to Medicare for patients who've had Breast Reconstruction Surgery and they have not paid on any of these claims.

Is there some guidelines/modifier that needs to be used in conjunction with a specific CPT to get these paid? How do we get Medicare to pay for a reconstruction/implant.

Please help!

Thank you!
 
Are you bumping up against global days with regards to the original surgery? Was the implant surgery documented as a planned procedure? Is it the surgery that is being denied or the implants themselves? Usually, the implants are provided by the facility and not billed by the surgeon. Can you give an example of all of the codes you submit?
 
The facility sends and gets paid for providing the implants. We do not bill any insurance company for the implants since our hospital provides them and bills for them.
 
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