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Labs soon will have to work harder to merit the maximum allowed Medicare payment for high-throughput tests used to detect SARS-CoV-2. The Centers for Medicare & Medicaid Services (CMS) has been paying labs $ 100 per test — up from $ 51 — since a public health emergency (PHE) for COVID-19 was declared on March 18, 2020. […]
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Based on the CPT manual instructions that intermediate and complex closures should be reported separately, my physician wants to add a 59 modifier to the closure.
It is my understanding that Medicare considers simple, intermediate and complex closure inclusive when the removal of the benign lesion is .5cm or less.
The codes are NCCI edits and can be overridden by adding modifier 59 to the repair. Since the repair is not a separate encounter, separate structure, separate practitioner or unusual non-overlapping service, would modifier 59 really apply?
CPT’s 11440
CPT’s 12011, 12051, 13151
Please advise.
Thanks,
Camille Waterhouse, CPC
If Congress and other stakeholders continue to drag their heels, Medicare bankruptcy is a real possibility. The Medicare Part A trust fund will be depleted by 2026 and Medicare Part B spending will grow more than 8 percent over the next five years, according to the 2018 Annual Report by Medicare’s Board of Trustees. Two things […]
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