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Scott Allen, director of managed care contracting for National Medical Billing Services, addresses the following reader's question:
Q: What the ambulatory surgery center level for CPT code 22523?
Scott Allen: The level, group or APC refers to a pricing structure for the reimbursement of CPT codes. The ASC level, or group, of a particular procedure could vary depending on payor. For example, in 2007, Medicare utilized grouper methodology many commercial carriers still use today.
Please note, commercial carriers sometimes apply a reimbursement methodology referred to as "the enhanced grouper method." The enhanced grouper method is simply reassigning CPT codes from Medicare's groupers into their own grouper levels. Make sure to compare carriers' groupers to 2007 Medicare groupers.
CPT 22523 was added to Medicare's ASC-approved procedures list in Jan. 2008 and allows $3,447.64 (2011 national average).
Learn more about National Medical Billing Services.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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