Medicare-No Pay For Certain Gastric Procedures

If you are a physician that does regular gastric by-pass procedures, you need to know that as of March 17th, Medicare will no longer reimburse the code 37216 which is transcatheter placement of intracatheter stents according to their latest transmittal from the Centers for Medicare & Medicaid Services.

Other changes that are coming soon will be to the physician reimbursement fee schedule. New medical billing claims need to show code 37216 to have the status code of “R,” and carriers should adjust their systems to “reflect a non-coverage status” for this particular code. Another change in the gastric medical billing category will be to restrictive procedure code 43842 that will have a status code of “A” assigned. This will designate that the procedure will also be non-covered by Medicare.

The new transmittal further revises descriptive modifiers for Category II modifiers 1P and 2P, and adds another modifier 3P make sure that your documentation of the gastric procedure performed matches the modifiers used. Make sure that you’re getting the maximum reimbursement for the procedures you perform and also make sure that your medical coding and billing reflects changes with Medicare so you know if you will be reimbursed for a procedure performed or not.

View all Articles by: Melissa Clark, CCS-P