Wiki UHC POLICY DEVICE DEPENDENT BILLING ASC

I am billing for an ASC that became in contract with UHC recently and the contract does not allow for separate payment of implants and joint devices as they are included in the allowable for each procedure code, however UHC has a device dependent procedure list that they require the associated device codes to be billed with or they will hit an edit and the claim will be rejected.

For example, CPT 27447 requires billing C1776

My question is: Do we need to bill for the entire cost of the purchased implant as listed on the invoice from the vendor or can we bill it at say $0.01? We have been billing at the invoiced rate however this is a lot of charges that are now being written off as C1776 is not separately reimbursed as outlined in our contract.


Thank you for any input you may be able to offer

We bill at the amount of the implant. It sure is frusturating! I'm curious to know what others do!

amy9686@gmail.com said:

We bill at the amount of the implant. It sure is frusturating! I'm curious to know what others do!

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Hi Amy, thank you for your response! This throught came about when we hit a rejection when billing for a MACI implantation where UHC has an edit for requiring a device code for the autologous chondrocyte however we do not bill for this tipically, the specialty pharmachy does and the vender advised us to bill the device code as $0.01, with a note that it was supplied by the pharmacy, which in returrn prompted us to think about the other deviece codes we use.