Billing > Facility Billing

Implant billing

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tlewis:
Fist what HCPC code are you using? if it is for anchor and screws I would use C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)
This code will not work for medicare (surprise surprise) for other implants I would use L8699.(doesn't work for medicare either) Generally you can bill cost plus 10% to cover shipping. I always send in an invoice with the cost of the implants or I get a denial stating that an invoice is needed. Since it is out of network and you are not contracted I wouldn't think that they wouldn't  deny the implant, but what I think and what the insurance company think usually don't jive so if they deny I would send in an appeal. I live in oregon and go off of the payment guidelines for work comp that states that implants are covered, so when I appeal I send a copy of the Oregon statute and have gotten paid. Good luck Implants are a pain!!!

georgina:
I don't have many problems with implant billing.  We bill cost plus 250% with rev. 278 and cpt 99070.  Out of network pay according to the patients OON benefits.  It is verified prior to surgery whether implants are covered under their OON policy.  Our contracted payers all have different guidelines for payment of implants.  Some require invoices others don't.  It is important for the physician to mention the specific implants in the operative notes in the event an appeal is needed.   

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