Tasneem Posted Tue 24th of March, 2020 11:40:51 AM
We are a pain management office. We are providing N95 masks to patients during their visits for their safety. What CPT/HCPCS code can I bill with for the N95 masks along with the follow up visit? If there's no CPT code for this yet, is there any CPT code that I can use to bill as unknown CPT or something? Please advise ASAP. Thanks!
SuperCoder Answered Wed 25th of March, 2020 06:19:22 AM
Thank you for your question,
There is no separate or specific HCPCS code that we can bill for N95 masks. However, HCPCS code A4928 (Surgical mask, per 20). This code represents 20 masks pack. It is used as surgical supplies and unbundles in the procedure performed. As of now there is no update on N95, so for above scenario mask will be included in the E/M visit. Feel free to ask for any further query.
Tasneem Posted Wed 25th of March, 2020 11:53:15 AM
Hi, I was researching to see if I can use a CPT that is for an unspecific supply and found this code below. Pls advise if I can use this.
CPT CODE: T5999
Description: UNDEFINED CODES
Supply, not otherwise specified
Use this code for any supply that is not specified by any other HCPCS code.
In the event that a patient receives a supply not covered by another HCPCS Level II code, use this one to report such a supply.
SuperCoder Answered Thu 26th of March, 2020 04:33:57 AM
In your scenario it is mentioned that you are providing N95 masks to patient. So, the closest code to bill will be A4928 (or we can use this as comparison code). However, you can go for T5999 (Supply, not otherwise specified) as well.
You may have to check with your payer and also, when submitting an unlisted-procedure code, your documentation should also include an explanatory cover letter, as to why you want to go for unlisted code. An insurer will decide to pay an unlisted-procedure claim by comparing your HCPCS code/ or whether it should be paid or bundled in E/M.
Hope it helps.
Tasneem Posted Thu 26th of March, 2020 14:51:47 PM
I cant bill with A4928 since its for 20 masks, so that's why I was asking about T5999. Do you have any sample cover letter I can use?
SuperCoder Answered Fri 27th of March, 2020 04:59:54 AM
There is no sample for cover letter. It is just that you need to have report (clear and accurate documentation) attached to claim, as why we are using N95. This separate report should explain in simple, straightforward language, exactly what the physician did and why we are using this unlisted procedure code.
Also, sometimes we give comparison code such as (A4928) so that an insurer will decide to pay an unlisted-procedure claim by comparing your procedure description to a similar, listed procedure with an established reimbursement value.