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billing 64495

Amani Posted Tue 20th of August, 2013 23:22:50 PM

CPT instruction not to bill the procedure 64495 more than once a day. MUE=1 according to Medicare. I have claims where the provider is billing with Quantity of more than 1(eg:2,3,4). Is that correct? Should I only pay for 1?

SuperCoder Answered Wed 21st of August, 2013 18:32:33 PM

It is clearly written under CPT 64495

(Do not report 64495 more than once per day)

Amani Posted Thu 29th of August, 2013 15:59:36 PM

so if the provider did both sides, the way to bill will be 64495- 50 with 1 quantity. Do we pay 100%of ASC for this procedure, or 150% of ASC since it is bilateral?

SuperCoder Answered Thu 29th of August, 2013 17:10:09 PM

Yes. Medicare makes payment for bilateral procedures based on the lesser of the actual charges or 150 percent of the Medicare Physician Fee Schedule (MPFS) amount when the procedure is authorized as a bilateral procedure. This Change Request implements the 150 percent payment adjustment for bilateral procedures.

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