| Invalid Services
| Topic:
Invalid Services |
Date
of Origin: December 2009 |
| Section: Administrative |
Policy
No: 107 |
| Last Reviewed Date:
April 2010 |
Last Revised Date:
March 2011 |
This policy applies to all physicians, other providers and non-hospital facilities. It applies to laboratory and radiology services from hospitals.
Definitions
Invalid services are those that are not eligible for
reimbursement.
Policy Statement
Providers will not be reimbursed nor allowed to retain
reimbursement for Invalid services. Invalid services
are denied provider write-off.
The following are examples of services that Asuris
considers to be Invalid. This is not an all inclusive
list.
- Allergen provision plus administration combined
codes. Services must be broken out and
reported using separate codes representing each service
(95120-92134
- Codes identified as not payable to professional
providers (e.g., S9083)
- Codes used in specific Regence Programs when the
provider is not contracted with or the member not
enrolled in that Program (e.g., S0281)
- CPT
category II supplemental tracking codes (0001F-7025F)
- HCPCS
National ‘T’ codes established
for state Medicaid agencies (T1000-T5999)
- Medicare clinical trial codes (G0293-G0294)
- Medicare demonstration project codes (G9001-G9140)
- Medicare
only codes (e.g., G0175 G0180)
- Medicare status ‘B’ codes (e.g., 36416 90885)
- Physician quality reporting indicator HCPCS codes
(PQRI) (G8006-G8544)
- Services that are included in the facility reimbursement
and not separately payable to professional providers
(e.g., 99026 99190)
- Services that are not direct face-to-face patient
care (e.g., 98966 99375).
- Services which Asuris does not contract for (S0270-S0274)
- Services which Asuris considers part of another
service and therefore not separately reimbursable
(e.g., 96904 94760)
- State Medicaid alcohol and drug abuse treatment
services (e.g., H0001 H2013)
- Surgical techniques requiring use of robotic surgical
system (S2900 - list separately in addition to code
for primary procedure)
- Tests, procedures or medical drugs that are considered obsolete
in nature (e.g., 92560 P2028, 90645)
Please refer to the Coding Toolkit on the Provider
Website for codes Asuris denies as Invalid.
References
None
Cross References
None
Your use of this Reimbursement Policy constitutes your agreement to be bound
by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.
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