DecisionHealth, DecisionHealth - 2022 Issue 8 (August)

Q&A: Don’t substitute autograft OATS code when payer won’t cover OATS with allograft

Question: We have recently received word from Medicaid that they will not pay the code 27415 (Osteochondral allograft, knee, open). Can we report instead the code 27416 (Osteochondral autograft knee, open [eg. Mosaicplasty] [includes harvesting of autograft]) with a modifier 52 (Reduced services)?

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