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CPT 37195

Nancy Posted Fri 29th of January, 2010 13:21:55 PM

Does the doctor bill for the cpt code 37195 when he orders TPA administration or does the hospital?

SuperCoder Answered Mon 01st of February, 2010 09:58:30 AM

As per Medicare these services are covered incident to a physician's service when they are provided by auxiliary personnel employed by the physician and working under his or her direct personal supervision. Payment may not be made by carriers for these services when they are provided to hospital inpatients or patients in a hospital outpatient department.

If your physician orders the t-PA but does not personally refill the implanted intrathecal/ ventricular pump or reservoir on an inpatient, then 95990 would be the appropriate CPT code but will not be reimbursable to the physician. Experts recommend reporting an appropriate E/M code to receive reimbursement for the t-PA administration. If the initial inpatient or follow-up codes do not apply, use a prolonged service code. Reimbursement for the t-PA service is included in any accompanying E/M service rendered during the same session.

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