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11980
Quick jump to procedure code: Printer Friendly Version
11982

CPT® 11981: INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT

Short Description: Insert drug implant device

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
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DIST of COL-DC + MD/VA Suburbs
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2016 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$143.31
$ 85.27

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 JulyUnadjusted OPPS Payment $ 91.18


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5734
Level 4 Minor Procedures

2016 OPPS Status Indicator: Q1

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
15.2% 185    Malignant neoplasm of prostate C61   Malignant neoplasm of prostate
7.2% 338.18    Other acute postoperative pain G89.18   Other acute postprocedural pain
5.3% 996.66    Infection and inflammatory reaction due to internal joint prosthesis T84.50XA   Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter
3.7% V43.65    Organ or tissue replaced by other means, knee Z96.659   Presence of unspecified artificial knee joint
2.8% 414.01    Coronary atherosclerosis of native coronary artery I25.10   Atherosclerotic heart disease of native coronary artery without angina pectoris
2.6% 715.16    Osteoarthrosis, localized, primary, lower leg M17.10   Unilateral primary osteoarthritis, unspecified knee
1.7% 715.96    Osteoarthrosis, unspecified whether generalized, lower leg M17.9   Osteoarthritis of knee, unspecified
1.3% 550.90    Inguinal hernia, without mention of obstruction or gangrene unilateral or unspecified (not specified as recurrent) K40.90   Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent
1.1% 730.27    Unspecified osteomyelitis, ankle and foot M86.9   Osteomyelitis, unspecified
1.0% 715.11    Osteoarthrosis, localized, primary, shoulder region M19.019   Primary osteoarthritis, unspecified shoulder

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

11981 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 11981

CCI and MUE Edits*         Hide this section.

CCI Edits for 11981
Denied Codes (1)
Effective
Modifier
Accepted (2)
0213T Njx paravert w/us cer/thor
07/01/2010 Yes
0216T Njx paravert w/us lumb/sac
07/01/2010 Yes
11982 Remove drug implant device
10/01/2002 No
36000 Place needle in vein
10/01/2002 Yes
36410 Non-routine bl draw 3/> yrs
10/01/2002 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
61650 Evasc prlng admn rx agnt 1st
01/01/2016 Yes
62318 Inject spine w/cath crv/thrc
10/01/2002 Yes
62319 Inject spine w/cath lmb/scrl
10/01/2002 Yes
64415 N block inj brachial plexus
10/01/2002 Yes
64416 N block cont infuse b plex
01/01/2003 Yes
64417 N block inj axillary
10/01/2002 Yes
64450 N block other peripheral
07/01/2002 Yes
64486 Tap block unil by injection
01/01/2015 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
64487 Tap block uni by infusion
01/01/2015 Yes
64488 Tap block bi injection
01/01/2015 Yes
64489 Tap block bi by infusion
01/01/2015 Yes
64490 Inj paravert f jnt c/t 1 lev
01/01/2010 Yes
64493 Inj paravert f jnt l/s 1 lev
01/01/2010 Yes
96360 Hydration iv infusion init
01/01/2009 Yes
96365 Ther/proph/diag iv inf init
01/01/2009 Yes
96372 Ther/proph/diag inj sc/im
01/01/2009 Yes
96374 Ther/proph/diag inj iv push
01/01/2009 Yes
96375 Tx/pro/dx inj new drug addon
01/01/2009 Yes
96376 Tx/pro/dx inj same drug adon
07/01/2009 Yes
J0670 Inj mepivacaine hcl/10 ml
07/01/2010 Yes
J2001 Lidocaine injection
07/01/2004 Yes
11983 Remove/insert drug implant
01/01/2002 No
(1) These codes will be denied when submitted for payment on the same date of service as 11981.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 11981


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   11981 Top 5 Ordering Providers National*
JEFFREY MENDELSON -WARREN,MI 216
DAVID MENDELSON -WARREN,MI 158
CHARLES TAUNT -LANSING,MI 139
NEIL BERCOW -ROSLYN,NY 117
JASON COCHRAN -LANSING,MI 114

   11981 Top 5 Ordering Organizations National*
PROHEALTH AMBULATORY SURGERY CENTER-NY 64
SOUTHERN INDIANA SURGERY CENTER, LLC-IN 14

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 11981*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 17,685
Total Services Denied 2014: 3,935 (22.3%)
National Charges Submitted 2014: $ 6,870,917.00
National Charges Allowed 2014: $ 741,459.00
National Average (No Modifier) Fee Submitted 2014: $335.34
National Average (No Modifier) Fee Allowed 2014: $105.79


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Orthopedic surgery 8,875 50.2% $378.77 890 10.0%
General surgery 1,438 8.1% $439.41 289 20.1%
Obstetrics/gynecology 1,322 7.5% $301.59 770 58.2%
Physician assistant
(eff 5/92)
1,281 7.2% $250.77 710 55.4%
Urology 1,205 6.8% $285.94 195 16.2%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Inpatient hospital 12,276 69.4% $385.66 2,130 17.4%
Outpatient hospital 2,656 15.0% $427.77 653 24.6%
Office 2,322 13.1% $308.65 1,070 46.1%
Ambulatory surgical center 405 2.3% $686.44 67 16.5%
State or local public health clinic 12 0.1% $144.35 11 91.7%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
51 - Multiple Procedures 6,544 37.0% $403.42 422 6.4%
No Modifier 3,814 21.6% $335.36 1,615 42.3%
59 - Distinct Procedural Service 2,765 15.6% $424.06 487 17.6%
AS 1,185 6.7% $355.53 686 57.9%
RT - Right Side 678 3.8% $510.64 64 9.4%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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07/24/2016 01:50:02 23.20.133.92

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