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Fecal Microbiota Transplant RVU'S and Pricing

Susan Posted Fri 07th of February, 2014 12:09:51 PM

Need help with cost for 44705, can't find any RVU's for this code, Medicare has RVU's for G0455. Commercial insurers we would bill 44705.
Any info on this code would be greatly appreciated.

SuperCoder Answered Mon 10th of February, 2014 16:20:23 PM

CMS did not accept the RUC recommendation RVU for 44705, but created HCPCS Code G0455
• Concern is Medicare payment for the preparation of the donor specimen would only be made if the specimen is
ultimately used for the treatment of a beneficiary.

• To bill for CPT code 44705 please use HCPCS code G0455 (Preparation with instillation of fecal microbiota by
any method, including assessment of donor specimen).

For Medicare, CMS has created a new HCPCS code for preparation of fecal microbiota. Code G0455 (Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen) includes the physician work for assessment of donors, preparation of fecal microbiota and instillation.

When this service is provided to a Medicare beneficiary, HCPCS code G0455 should be billed instead of code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen). In the Physician Fee Schedule Final (PFS) Rule for fiscal year (FY) 2013, CMS stated “Within Medicare, payment for the preparation of the donor specimen would only be made if the specimen is ultimately usedfor the treatment of a beneficiary as Medicare is not authorized to pay for any costs not directly related to the diagnosis and treatment of a beneficiary. Because of this policy, we believe it is appropriate to bundle the preparation and instillation into one payable HCPCS code.”

As CMS will only reimburse for preparation and assessment of a fecal microbiota sample if the sample has been used in the treatment of the patient, CMS has combined both the microbiota sample prep and instillation in the HCPCS code, G0455. So, you will only report this code and not report any additional code for the placement of the specimen

Susan Posted Tue 11th of February, 2014 10:54:22 AM

If the patient is non-medicare, we would still use the G0455?

SuperCoder Answered Tue 11th of February, 2014 10:58:13 AM

That's what is said above.

Thanks,

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