Wiki Refilling of implantable pump(95990)

[missyah20]

Does anyone have any information on this code? My provider is billing for this code with a POS 22. Medicare has denied stating "Treatment was deemed by payer to have been rendered in an inappropriate or invalid POS." Does anyone have a link to any Medicare guidelines or informaiton for this code? Thank in advance!

 

[RebeccaWoodward*]

95990 is administered by a professional who is not a physician. CPT code 95991 is performed by a physician. Could this be the issue? The POS shouldn't be an issue. This service can be performed outpatient per the CMS hospital list.

I'm not sure which region you're in but I have attached one Medicare link.

https://www.noridianmedicare.com/sh...ing_or_Refilling_of_an_Implantable_Device.htm

http://www.medtronic.com/neuroreimbursement/downloads/MTAPainPmpCBCPhy4-08.pdf

 

[missyah20]

OK, so that is probably the problem I am having. This is being performed by an MDA. So I should be using 95991, right? I just want to be sure. Thanks for your help!

 

[comunale]

Medicare payment for 95990?

We recently had a denial for a nurse practitioner who performed a pump refill. We used 95990 which looks like the correct code but Medicare denied it saying it was not a covered code? Any ideas?