tci Medicare Compliance & Reimbursement - 2024 Issue Q2

Reader Questions: Know What Traditional Medicare Won’t Pay Extra For

Question: I thought Medicare does not pay extra for physical status modifiers or qualifying circumstances add-on codes, but a colleague told me they are billing these and receiving payment. Do you know if Medicare has changed its policy? Florida Subscriber Answer: Traditional Medicare does not recognize qualifying circumstances for additional payment, nor does it recognize or pay additional units for physical status — everything is bundled into the payment for the anesthesia service. It’s possible your colleague was referring to Medicare Advantage or Medicare replacement plans, which might provide coverage. Some of these plans follow Traditional Medicare guidelines...

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