Wiki Urolift 52441 and 52442 excess number of units

[AprilPerry]

Does anyone have experience with providers billing over the 6 allowed units for 52442? I know the urolift rep states that you can and can use appeal letters and so forth but I am looking specifically at regular Medicare. Has anyone had a claim to pay with more than the 6 units by a regular Medicare plan? I have only spoke with one other Urology rep thru AAPC and her docs only bill the allotted units. Any help is appreciated.

 

[liqgold2@aol.com]

Any use of transplants over 6 will need authorization from the carrier.

 

[amanda.hackett@auihealth.com]

Yes, we have had Medicare pay more than the 6 units. With a strong appeal and a letter of medical necessity from the doctor stating why more implant were needed.