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Billing instructions for implanted prosthetic devices with HCPCS code C9899: Reason code 32354
Last Modified: 8/28/2024
Location: FL, PR, USVI
Business: Part A
As outlined in CMS internet-only manuals (IOMs), hospitals are permitted to bill for implantable prosthetic devices furnished to hospital inpatients that do not have Medicare Part A coverage if the patient is covered under Medicare Part B.
To promote consistency in the claim submission process, First Coast, is asking providers to follow the instructions outlined below.
• Type of bill (TOB) = 12x
• Claim page 02 in the Fiscal Intermediary Standard System (FISS) via Direct Data Entry (DDE) or electronic media claim (EMC) equivalent:
• HCPCS C9899 and the amount that would have been charged with the actual device code itself (this is the amount outlined on the device purchase invoice)
• Include any other services rendered for this stay that are billable on a 12x TOB
• Do not include the “C” HCPCS code of the actual device itself on claim page 02 in FISS (or the EMC equivalent)
• Claim page 04 (remarks) in FISS via DDE (or the EMC equivalent):
• Include detailed remarks outlining the HCPCS code that C9899 is representing and a description of the device itself and/or a HCPCS code that adequately describes the device, the procedure being performed, the type of implants inserted and the invoice number along with the acquisition cost for each component implanted. The shipping cost does not need to be included.
Hospital A admits patient for a total left knee arthroplasty (left knee replacement). Patient does not have Part A coverage, but per CMS guidelines, the hospital bills for the implantable prosthetic device. In this scenario, hospital A would traditionally bill HCPCS C1776 with a charge as outlined on the device purchase invoice.
• TOB = 121
• Claim page 02 in FISS via DDE or EMC equivalent = HCPCS C9899 with total and covered charges
• Any of other services rendered that are billable on an inpatient Part B claim (12x TOB) may also be included for payment
• Claim page 04 in FISS via DDE or EMC equivalent = HCPCS C1776 as well as an equivalent narrative description of the prosthetic device
Additional information is needed to review C9899. Please provide the following information in a detailed remark:
• The type of procedure in which the implant components are being used, such as “hip replacement”
• The name of each implant followed by the invoice number and acquisition cost of the implant, such as “screw 3.5mm x 7mm/ invoice 157891/$50.00”
Do not include the shipping cost as part of the acquisition cost for each component.
Note: It is not uncommon for multiple invoices with different numbers to be used when obtaining components for procedures. Therefore, please include the invoice number in the comments for each component.
Claims submitted without the necessary information will be returned to provider (RTP) with reason code 32354.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.