tci Part B Insider - 2013 Issue 6

Reader Question: Don't Look for Clip Placement Pay

Question: We reported +19295 (Image guided placement, metallic localization clip, percutaneous, during breast biopsy/aspiration [List separately in addition to code for primary procedure]) last week and the claim got rejected, with the EOB saying that only the facility charge (and not the professional charge) would be allowed. Should I appeal this denial? Texas Subscriber Answer: No, you needn’t appeal. Code +19295 (Image guided placement, metallic localization clip, percutaneous, during breast biopsy ...) is for placing a clip. However, there is no reimbursement for this code. How it works: If you look at the relative value unit (RVU) structure...

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