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Billing for Alloderm Q4116 on Professional claim

Victoria Posted Wed 01st of March, 2017 09:36:39 AM
If a surgeon is doing a procedure in the ASC, is it ok to bill for the Alloderm Q4116 on the professional claim if it is not covered on the ASC claim?
SuperCoder Answered Thu 02nd of March, 2017 08:07:51 AM

Hi,

Our team is working on it and will get back soon.

SuperCoder Answered Fri 03rd of March, 2017 01:54:27 AM

If the ASC furnishes items of implantable DME to patients, the ASC bills and receives a single payment from the local contractor for the covered surgical procedure and the implantable device, as long as the implantable device does not have pass-through status under the OPPS. When the surgical procedure is not on the ASC list, the physician bills for his or her professional services and the ASC may bill the beneficiary for the facility charges associated with the procedure.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c14.pdf

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