Joshua Posted Thu 02nd of July, 2020 13:17:20 PM
What would be the maximum allowable amount of units to bill for the Technical component of CPT 95885 and CPT 95886? The MUE states 4 per day. Is this billed by extremity? Please let me know if you need more info. Thanks!
Joshua Posted Thu 02nd of July, 2020 13:22:35 PM
For instance, would we be reimbursed $40.72 (Tech side) x4 units ($162.88), or would we receive only the single $40.72 TC payment regardless of units billed?
SuperCoder Answered Fri 03rd of July, 2020 03:57:56 AM
Thanks for your question.
If five or more muscles in a single extremity, supplied by three or more nerves or at four or more spinal levels, are tested, report one unit of +95886. You can report +95885 or +95886 once for each extremity tested, so you can report either code 4 times if all 4 extremities are tested.
Use 95885 when 1-4 muscles are tested in an extremity. Use 95886 when 5 or more muscles are tested in an extremity.
Report either 95885 or 95886 once per extremity. Codes 95885 and 95886 can be reported together up to a combined total of four units of service per patient when all four extremities are tested.
Regarding payment, please note that if you append modifier TC to code 95885, you will receive a payment of $44.75 for one unit. And if you report 4 units, you will receive a payment of 44.75 x 4 = $179.00.
And if you append modifier TC to code 95886, you will receive a payment of $51.97 for one unit. And if you report 4 units, you will receive a payment of 51.97 x 4 = $207.88.
NOTE: Because +95885 and +95886 are add on codes, payers will not reimburse you if you report these without an appropriate primary code, which you can report using codes 95905 - 95913, Nerve conduction tests.
Hope this helps. Please feel free to write if you have any question.