DISCLAIMER: Procedure coding should be based upon medical necessity and services, procedures and supplies provided to the patient. Coding and reimbursement information is provided for educational purposes and does not guarantee coverage of the specific item or service in a given case. It is not intended to maximize reimbursement by any payer. Circassia and The Pinnacle Health Group make no guarantee of coverage or reimbursement of fees. Contact your local Medicare Administrative Contractor (MAC) or CMS for specific information as payment rates listed are subject to change and will vary by payer and region. To the extent that you submit cost information to Medicare, Medicaid or any other reimbursement program to support claims for services or items, you are obligated to accurately report the actual price paid for such items, including any subsequent adjustments. Circassia disclaims any responsibility for claims submitted by providers. It is the provider’s responsibility to determine appropriate codes, charges, and modifiers, and to submit bills for services and products consistent with what was rendered as well as the patient’s insurer requirements. CPT® is a registered trademark of the American Medical Association.
Reference: 1. January 2007 Nonoutpatient prosecptive payment system (non-OPPS) outpatient code editor (OCE) specifications version 22.1. Centers for Medicare and Medicaid Services. Published January 1, 2007. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1150CP.pdf. Accessed August 20, 2018.
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