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Stool Transplant on a Medicare Patient

Vickie Posted Mon 18th of February, 2013 17:40:35 PM

My physician is doing the stool transplant procedure. We are being told by a hospital consultant that when he does a stool transplant on a Medicare patient he can only charge the 'G0455'. My physician is instilling the stool via the colonoscopy method. He is going all the way to the cecum; however, we are being told the only code we can charge for the Medicare patient is'G0455'. We are in the state of North Carolina. We have Palmetto Medicare as our carrier.

Vickie Terry

SuperCoder Answered Tue 19th of February, 2013 10:45:45 AM

In CPT 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen) is a new gastroenterology procedure for Stool Transplant but CMS does not accept RUC (Relative Value Scale Update Committee) recommended RVU and has created HCPCS Code G0455 for this procedure. 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).

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