02/24/2017

Billing for CPT codes 11721, 11056 and 93992

Medicare B how to get paid for 11721 11056 93992. How do I get paid for this?

For the ABI, the testing service is not payable with the ASO diagnosis listed. The LCD policy has the list of covered conditions for this service. When billing on a claim with routine foot care procedures, this should be the first line item billed:

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33627&ver=51&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=New+York+-+Entire+State&CptHcpcsCode=93922&bc=gAAAACAAAAAAAA%3d%3d&

For CPT 11055, systemic condition should be billed as primary, with L85.2 billed as the secondary diagnosis. This should be billed as the second line item on the claim with the applicable Q modifier.

For CPT 11721, B35.1 should be billed as the primary diagnosis with the systemic condition secondary.This should be billed as the third line item on the claim with modifier 59 as the first value and the Q modifier secondary.

Depending on the systemic diagnosis billed, a referring provider and DLS may be required in order to get the charges paid. I70.219 is not a covered condition. See the link below for what systemic conditions are covered and what may require additional information such as referring providers of a DLS:

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33636&ver=33&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=New+York+-+Entire+State&CptHcpcsCode=11055&bc=gAAAACAAAAAAAA%3d%3d&