The Centers for Medicare and Medicaid Services provide additional information on reimbursement, including an option to search for both National and Local Coverage Decisions.
The Implementation of the UB-04 fact sheet is now available in downloadable format from the Medicare Learning Network (MLN). This fact sheet reviews the new UB-04 paper claim form which is only accepted from institutional providers excluded from the mandatory electronic claims submission. It includes background information, the transition period and a crosswalk. To view, download, or print, select the title of the fact sheet from www.cms.hhs.gov/MLNProducts/MPUB/list.asp on the MLN Publications web page.
Arthrex Coding Hotline: 877-734-6289 Email: email@example.com
Effective January 1, 2005, hospitals are required to use Medicare C-codes when billing for devices used in the outpatient setting.
Requiring the use of C-codes to identify devices used in conjunction with procedures paid under OPPS will greatly improve the quality of claims data Medicare uses to establish APC payments in the future. The full list of C-codes can be found on the CMS website under 2005 Alpha-Numeric HCPCS File.
Medicare has established outpatient coding edits dictating which specific C-codes should be billed with which CPT procedure code. The list of coding edits is not all-inclusive and Medicare will update the list on a quarterly basis in conjunction with the quarterly Outpatient Coding Editor (OCE) release. Visit the CMS website for more information on the C-code edits.
Please contact your local fiscal intermediary, or contact an Arthrex reimbursement specialist if you have questions regarding reimbursement for Arthrex products and technologies: 877-734-6289. Alternatively, please send questions and comments to an Arthrex reimbursement specialist via the form below.
Disclaimer: The information provided on this website was obtained from many sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. All content on this website is informational only, general in nature, and does not cover all situations or all payers' rules and policies. This content is not intended to instruct medical providers on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that we assume will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for healthcare procedures.
This website information represents no promise or guarantee concerning coverage, coding, billing, and payment levels. Arthrex specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information on this website.