Author Topic: Medicare Reimbursement for 64555-SG, Surgical procedure  (Read 3308 times)

stacykelley

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Medicare Reimbursement for 64555-SG, Surgical procedure
« on: October 09, 2014, 10:32:09 AM »
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, 10:40:10 AM »
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, 11:16:07 AM »
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, 12:39:22 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, 06:10:00 AM »
Same with me i dont found any solution. May be some ASC codes change.

Ruthie1972

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Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Reply #5 on: February 23, 2016, 02:19:16 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?