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cpt code 64520

Rose Posted Tue 30th of June, 2020 16:57:32 PM
I've been getting denials for cpt code 64520 can you please let me know if there's been any change? I used to bill with modifier 25 for the 99213-4 for this procedure and got paid but now i don't get paid
SuperCoder Answered Wed 01st of July, 2020 08:20:23 AM

Hi Rose,

Thank you for your question.

CPT 64520 and E/M can be billed together with modifier 25, as of now there is no change. However, remember that the E/M service performed with the procedure must be both significant and separately identifiable to justify the use of modifier 25. Minor surgeries and procedures include pre-procedure, intra-procedure, and post-procedure work, so you should never report a separate E/M service for this work.



CMS confirmed that it plans to align E/M coding with the American Medical Association Current Procedure Terminology Editorial Panel changes for outpatient/office E/M visits. It also accepted the recommended work values from RUC for services. However, these changes don’t go into effect until 2021, although it’s essential to begin familiarizing yourself with them. 

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