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Issue Number - Name
0104-Add-ons paid without a Primary and/or Denied code by ASC
Review Type
Automated
Claim Type
A0mbulatory Surgical Center (ASC)
Region and State
RAC 1-4
All States
Date Approved
2018-07-10

Description

CMS has designated certain codes as "add-on procedures". These services are always done in conjunction with another procedure and are only payable when an appropriate primary service is also billed.  ASC providers paid for Add-On HCPCS/CPT codes without the required Primary code/or Denied Primary code will be denied.

Affected Code(s)

None

Applicable Policy References

  • Social Security Act, Section 1833, (e)
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30 D
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 01, Section 70 
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, Section 40.8 
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 29, Section 240
  • https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Add-On-Code-Edits.html
  • AMA CPT code book