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any biller had luck billing '0161T'

Aimie Posted Thu 04th of February, 2010 21:32:35 PM

SuperCoder Answered Fri 05th of February, 2010 06:24:26 AM

CPT 0161T is not a covered service by Medicare because it is considered as Investigational, Unproven or Experimental. In order to bill such kind of services you need to sign an ABN before the service is rendered. Also, you need to use an appropriate modifier (like GA, GZ or GY.

Deborah Answered Thu 18th of February, 2010 22:31:05 PM

What about billing 0213T, Injection, diagnostic or therapeutic agent etc, with U/S guidance. We are wanting to use this code bat cannot find any reimbursement info. I think with this wording we will only get paid for the medication used. please advise anyone!!!

SuperCoder Answered Fri 19th of February, 2010 17:12:11 PM

0213T, being a category III code, is "carrier-priced". Usually Medicare will not pay for this code (plz see Alex's response above regarding other Cat. III codes). Another option is to code the service with an unspecified CPT category I code, but that is not advisable because the cat. III codes are required to be coded and recognized by the payor for data-collection purpose. No reimbursement info will be available under physician fee schedule for this code, as it's carrier-priced. Because T-Codes do not
have an established Medicare national payment rate or assigned relative value units,
providers should determine the appropriate charges consistent with their customary
billing practices and in compliance with insurer policies. If the payor has not established a payment rate for this Px (0213T), the physician will need to submit a request for a specific payment amount for the procedure.

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