Forum - Questions & Answers
Prostate saturation biopsies--Pathology question
We have billed G0416 to NGS Medicare and payment has been denied. The reason that we are being given for the denial is that these codes (G0416 through G0419) are payable only in a physician's office (11), independent clinic (49) or independent lab (81).
This service was performed by a pathologist and was billed as outpatient place of service because he is based in the hospital.
We cannot find anything to confirm that this code is not payable in outpatient POS. We also cannot find anything to confirm that it is only payable in the places of service listed above. I am wondering if anyone else has run into this situation?
Thank you. Donna
perhaps
the surgeon did not report the correct procedure code 55706 but rather the routine biopsy so that is the rejection.