Tsai Posted Wed 26th of June, 2019 18:55:25 PM
One of our patient was authorized for PRP injection to her left elbow by the insurance company. We billed 02322T for PRP injection which we thought it should be correct. The insurance however only paid $67.71 for service. After we appealed, they issued additional $13.78 payment which was really not acceptable. We purchased our PRP kit at the price of $250.00. Beyond the service we provided, we are losing money even for the purchased kit. We want to appeal again for the kit we had used for this patient. I want to ask if any CPT code for PRP kit so we could fight again to minimize our loss. Thank you. TsaI Chao
SuperCoder Answered Thu 27th of June, 2019 07:01:22 AM
Thanks for your question.
Please let us know if you had billed HCPCS code also for PRP product to be paid for the supply. The code is P9020 (Platelet rich plasma, each unit) and you should have billed the total no. of units used.
Tsai Posted Thu 27th of June, 2019 09:58:00 AM
Thank you for your reply. We only billed 02322T on CMS 1500 form because we thought this CPT code included all things. What should we do right now ? Please suggest ! Thank you.
SuperCoder Answered Fri 28th of June, 2019 04:36:54 AM
Now in this case, you need to re-submit the corrected claim with a request letter to the insurance stating the reason of re-submitting the claim. You need to mention that you missed to bill the HCPCS code for the PRP kit because of which you were not paid for the PRP kit.
Hope this helps.
Tsai Posted Fri 28th of June, 2019 08:53:06 AM
Ok, thank you for your help.
SuperCoder Answered Mon 01st of July, 2019 01:21:12 AM
Thank you, happy to help.