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April Coding Q&A

Members & Publications

April 23, 2018

Got coding questions? Your Academy has the answers. Each month we feature a member’s question with an answer provided by AAPM&R’s Reimbursement and Policy Review Committee (RPRC).

Q: I recently performed a platelet rich plasma (PRP) injection on a patient using a kit provided to me for free by a sales rep. How do I bill for this service given that I didn't pay for the materials associated with it? Is it a reduced service? And, since PRP is a self-pay service, how much should I charge the patient?

A: Coding is not impacted by how supplies are obtained; be it through a sales rep for free, at a reduced rate, or at regular price. So in the instance you've described, the normal coding for this procedure applies. For PRP injections, the appropriate code to bill is 0232T. There is no need to add a reduced services modifier. Additionally, your normal charge for PRP is appropriate in this instance.

Find additional resources related to reimbursement here. Do you have a coding or billing question? Contact AAPM&R at codingquestions@aapmr.org for assistance. 

Accurate coding is the responsibility of the provider. This article is intended only as a resource to assist in the billing process.


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.

 

 

 

 

 

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