Author Topic: Medicare Reimbursement for 64555-SG, Surgical procedure  (Read 11077 times)

stacykelley

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Medicare Reimbursement for 64555-SG, Surgical procedure
« on: October 09, 2014, 01:32:09 PM »
I have been charged with a mission from a prospective employer to solve this problem contingent on his hiring me.  I have little info other than this:

The code 64555-SG has been billed to Medicare by a prospective client of theirs, and although the standard of reimbursement by Medicare is in the $700-$800 range, this client presented an EOB showing that 64555-SG being paid at $3800.  It was billed under Medicare part B, I am told it was only billed as 1 unit.  I don't know if it was billed under the provider or the facility.  Our location is Southern California, and this EOB allegedly is from the same jurisdiction.  The Noridian website indicates that this code reimbursement is in the $700-$800 range, so I can't figure out how this client was paid $3800 (multiple payments for multiple patients on the same EOB). 

If anyone has any information to help me, I would be so very grateful.  It may land me a job!

Merry

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Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #1 on: October 09, 2014, 01:40:10 PM »
Seems to me after doing a Google search that it is a facility fee for the ASC. Some of my searches showed that it is not used anymore and other searches contradicted this.

stacykelley

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Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #2 on: October 09, 2014, 02:16:07 PM »
Yes, that is exactly what I have found.  Plus the reimbursement has varied from state to state.  As the owner of this billing company, if he and all of his billers can't figure it out, I'm about finished trying.  This has been a week-long interview with no pay and only stress  :-\

Merry

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Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #3 on: October 09, 2014, 03:39:22 PM »
You are smart. Sounds like this would not be  good fit. Hope you find a job that you will be appreciated at.

jessyp

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Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #4 on: November 17, 2015, 09:10:00 AM »
Same with me i dont found any solution. May be some ASC codes change.

Medical Billing Forum

Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #4 on: November 17, 2015, 09:10:00 AM »

Ruthie1972

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Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #5 on: February 23, 2016, 05:19:16 PM »
You would have to call Medicare and verify that the payment is correct, I have come across claims being paid twice due to submitted duplicate claims with different amounts due to the PQRI. Maybe they just want to see your "problem solving" skills?

BikhamHCare

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Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #6 on: April 17, 2018, 06:11:32 PM »
What it seems to me, the claim is meant to be processed by your Insurance Company. Even though, standard charges for the procedure fluctuates from State to State – it is advised to better consult your Insurance provider. In majority of the cases received charges are listed along with, “what can be paid and what is to be denied”. Google doesn't seem to help much in providing the prominent solution to your query, it would be advised if you could go look for an offline expert advise for 64555-SG.

HABA

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Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #7 on: July 27, 2019, 05:37:16 PM »
Medicare discontinued "SG" Modifier in 2008.

Medical Billing Forum

Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #7 on: July 27, 2019, 05:37:16 PM »