All codes published on the National Physician Fee Schedule (NPFS) by the Centers for Medicare and Medicaid Services (CMS) are assigned a status code. This policy addresses specific codes assigned status code "I" where CMS has indicated a replacement code is available and has assigned a Relative Value Unit (RVU) to the replacement code.
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Q: If the provider reports CPT code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen) which has an NPFS status code of “I”, will it be reimbursed?
A: No. Consistent with CMS, UnitedHealthcare will deny reimbursement of specified status “I” codes on the NPFS that have been assigned a replacement code by CMS. In this instance, a single code, replacement code HCPCS G0455 (Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen) which includes both the work of preparation and instillation of the microbiota, should be reported.