Add-on codes are reimbursable services when reported in addition to the appropriate primary service by the Same Individual Physician or Other Qualified Health Care Professional reporting the same Federal Tax Identification Number on the same date of service unless otherwise specified within the policy. Add-on codes reported as Stand-alone codes are not reimbursable services in accordance with Current Procedural Terminology (CPT®) and the Centers for Medicare and Medicaid Services (CMS) guidelines.
For the purpose of this policy, the Same Individual Physician or Other Qualified Health Care Professional is the same individual rendering health care services reporting the same Federal Tax Identification number.
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Q: How would the policy handle the billing of codes 13102 (Repair) and 13100 (Repair) on the same date of service, by the same physician?
A: In accordance with CPT guidelines, Add-on code 13102 is to be used in conjunction with code 13101 only. Therefore, code 13102 reported without the appropriate primary code, 13101 will not be separately reimbursed.
Q: How has UnitedHealthcare determined which codes are "Add-on" codes that must be reported with a primary service?
A: The policy follows CPT guidelines for those codes designated with a "+" symbol. These codes are considered to be Add-on codes by UnitedHealthcare.
Q: Does UnitedHealthcare require the Add-on code be submitted on the same claim as the primary code?
A: No. The Add-on code may be reported on a separate claim submission from the primary code; however it is recommended the Add-on and primary procedure codes be reported on the same claim form.