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I need help on cpt 25111

Fion Posted Fri 06th of November, 2015 16:34:35 PM

I just got the recoup payment request from the Unitehealthcare. the cpt 25111 was preform in the office setting. 11 is the place of service.
on the recoup letter, the reason for the recoup the payment is:cpt 25111 billed with place of service 11 has been identified by the CMS as non-eligible service performed in non-facility setting.
Can you help me verify this code, how to check this code is eligible or not eligible for the place of service: 11. Please feel free to contact me at 718-290-2906. Thank you for your time!

SuperCoder Answered Mon 09th of November, 2015 06:23:55 AM

Hi Yang,

This procedure safely and effectively performed in an ASC or other outpatient setting without compromising the quality of patient care. These services are performed in ASC or lower-level setting such as a physician's office, unless the physician has contacted the contractor/insurance to pre-clarify benefit coverage policies.

For this case, you should check with your contractor/insurance that they cover minor ortho procedures in an office setting and to bill POS 11 with CPT 25111, prior authorization is required. If there is no prior authorization, claim may deny.

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