Description
Based on CPT Code descriptions, CPT Code 17000 may only be billed once per date of service; CPT Code 17003 may only be billed thirteen times per date of service, and CPT Code 17004 may only be billed once per date of service. If billed in excess of these limits, excess units of CPT codes 17000, 17003 and/or 17004 will be recovered.
Affected Code(s)
17000, 17003, 17004
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
3. 42 CFR §405.929- Post-Payment Review
4. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
5. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 CFR §405.986- Good Cause for Reopening
7. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
8. American Medical Association (AMA), Current Procedural Terminology (CPT) 2015 –current (Destruction, Benign or Premalignant Lesions)
9. Palmetto GBA LCA A56346- Billing and Coding: Removal of Benign and Malignant Skin Lesions; Effective 01/01/2019; Revised 5/12/2022
10. CGS Administrators, LLC, LCA A57044- Billing and Coding: Removal of Benign Skin Lesions; Effective 09/26/2019; Revised 7/29/2021
11. NGS LCA A54602- Billing and Coding: Removal of Benign Skin Lesions; Effective 10/01/15; Revised 5/07/2020
12. Novitas LCA A57113- Billing and Coding: Removal of Benign Skin Lesions; Effective 09/26/19; Revised 01/12/2022
13. WPS, Local Coverage Article (LCA) A57482- Billing and Coding: Removal of Benign Skin Lesions; Effective 10/31/2019; Revised 10/28/2021