Find-A-Code Focus Newsletter

Who Knew? There are Three Types of Add-On Codes

By Chris Woolstenhulme
January 21, 2020

Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such as “Use Additional “. Add-On codes are updated with their primary procedures each year in January. Quarterly updates may be posted as well.

When are they used?

  • Add-on codes must be reported in conjunction with another primary service.
  • Add-on codes are only reported if the primary procedure is performed by the same practitioner.

Identifying an Add-on Code

  • Identified as a Type I, Type II or Type III, add-on code.
  • The Medicare Physician fee schedule database generally has a global period of “ZZZ”.
  • Designated by the symbol "+" on Find-A-Code's code page and by the CPT manual.
  • Coding instructional notes generally include phrases such as "each additional" or "(List separately in addition to primary procedure)."

How does CMS process Add-On Codes?

  • Type I add-on codes are never paid unless a listed primary procedure code is also paid.
  • See CMS Pub-100-04, Chapter 12, Section 30.6.12(I).
  • According to CMS, the add-on codes are in three groups to distinguish the payment policy for each group. 

Groups of Code Types

  1. Type I - A Type I add-on code has a limited number of identifiable primary procedure codes. The CR lists the Type I add-on codes with their acceptable primary procedure codes.  A Type I add-on code, with one exception, is eligible for payment if one of the listed primary procedure codes is also eligible for payment to the same practitioner for the same patient on the same date of service.  Claims processing contractors must adopt edits to assure that Type I add-on codes are never paid unless a listed primary procedure code is also paid. 
  1. Type II - A Type II add-on code does not have a specific list of primary procedure codes. The CR lists the Type II add-on codes without any primary procedure codes. Claims processing contractors are encouraged to develop their own lists of primary procedure codes for this type of add-on codes.  Like the Type I add-on codes, a Type II add-on code is eligible for payment if an acceptable primary procedure code as determined by the claims processing contractor is also eligible for payment to the same practitioner for the same patient on the same date of service. 
  1. Type III-A Type III add-on code has some, but not all, specific primary procedure codes identified in the CPT Manual. The CR lists the Type III add-on codes with the primary procedure codes that are specifically identifiable. However, claims processing contractors are advised that these lists are not exclusive and there are other acceptable primary procedure codes for add-on codes in this Type. Claims processing contractors are encouraged to develop their own lists of additional primary procedure codes for this group of add-on codes.  Like the Type-I add-on codes, a Type III add-on code is eligible for payment if an acceptable primary procedure code as determined by the claims processing contractor is also eligible for payment to the same practitioner for the same patient on the same date of service.

 

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