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Issue Number - Name
0130-Medical Neccesity Pannulectomy
Review Type
Complex
Claim Type
Outpatient Hospital, Ambulatory Surgical Center, Physician/Non-Phsycian Services
Region and State
RAC 1-4
All A/B MACs
Date Approved
1/08/2019

Description

If a panniculectomy is billed at the same time as an open abdominal surgery or is incidental to another procedure, it is not separately payable. In addition, documentation will be reviewed for medical necessity.

Affected Codes

15830 (See Appendix D for other related/affected codes)

Applicable Policy References

Social Security Act: Section 1833(e), 1862(a)(1)(A), 1862(a)(10)
42 CFR, 405.980(b) and (c); 405.986; 411.15(k)(1); 424.5(a)(6)
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16, Section 10, 20
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16 Section 120
National Correct Coding Initiative Policy Manual, Chapter 6, E, 8
Medicare Claims Processing Manual Chapter 12, Section 40.6 (A)
Novitas LCD L35090,Effective 10/1/2015, Revised 4/14/2017
WPS L34698, Effective 10/01/2015, Revised 01/01/2018, 02/01/,10/01/2016, 01/01/2017
Palmetto GBA L33428, Effective 10/01/2015, Revised 10/1/18
Annual American Medical Association: CPT Manual