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11980
Quick jump to procedure code: Printer Friendly Version
11982

11981: Insert drug implant device CPT® 11981: INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT

Short Description: Insert drug implant device

--

CPT copyright 2016 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2017 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$143.91
$ 85.77

2017 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2017 October Unadjusted OPPS Payment $100.02


*Based on National 2013 Medicare Part B submitted claims.
2017 APC Code: 5734
Level 4 Minor Procedures

2017 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.
Percentage
ICD-10 Code
Description
Related DRG(s)
10.1%
Z30.49
Encounter for surveillance of other contraceptives
951
6.0%
T84.51XA
Infection and inflammatory reaction due to internal right hip prosthesis, initial encounter
485-489
559-561
6.0%
M17.11
Unilateral primary osteoarthritis, right knee
553-554
5.5%
M17.12
Unilateral primary osteoarthritis, left knee
553-554
5.5%
T84.53XA
Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter
485-489
559-561
5.1%
T84.52XA
Infection and inflammatory reaction due to internal left hip prosthesis, initial encounter
485-489
559-561
4.6%
T84.54XA
Infection and inflammatory reaction due to internal left knee prosthesis, initial encounter
485-489
559-561
2.8%
C61
Malignant neoplasm of prostate
715-718
722-724
2.3%
T81.89XA
Other complications of procedures, not elsewhere classified, initial encounter
919-921
1.8%
M86.9
Osteomyelitis, unspecified
485-489
539-541

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

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.

Column 1 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
11000 Debride infected skin
10/01/2016 Yes
11001 Debride infected skin add-on
10/01/2016 Yes
11004 Debride genitalia & perineum
10/01/2016 Yes
11005 Debride abdom wall
10/01/2016 Yes
11006 Debride genit/per/abdom wall
10/01/2016 Yes
11042 Deb subq tissue 20 sq cm/<
10/01/2016 Yes
11043 Deb musc/fascia 20 sq cm/<
10/01/2016 Yes
11044 Deb bone 20 sq cm/<
10/01/2016 Yes
11045 Deb subq tissue add-on
10/01/2016 Yes
11046 Deb musc/fascia add-on
10/01/2016 Yes
11047 Deb bone add-on
10/01/2016 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
62324 Njx interlaminar crv/thrc
01/01/2017 Yes
62325 Njx interlaminar crv/thrc
01/01/2017 Yes
62326 Njx interlaminar lmbr/sac
01/01/2017 Yes
62327 Njx interlaminar lmbr/sac
01/01/2017 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
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
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
96377 Applicaton on-body injector
01/01/2017 Yes
97597 Rmvl devital tis 20 cm/<
10/01/2016 Yes
97598 Rmvl devital tis addl 20cm/<
10/01/2016 Yes
97602 Wound(s) care non-selective
10/01/2016 Yes
J0670 Inj mepivacaine hcl/10 ml
07/01/2010 Yes
J2001 Lidocaine injection
07/01/2004 Yes
(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.



Column 2 CCI Edits for 11981
Denied Codes (1) Effective Modifier
Accepted (2)
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*
PAUL GREENLAW -NEW BERN,NC 167
JEFFREY MENDELSON -WARREN,MI 132
CHARLES TAUNT -LANSING,MI 116
CHARLES KOLLMER -EDGEWATER,FL 107
EDWARD MCPHERSON -LOS ANGELES,CA 106

*Based on 2015 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 2015: 17,354
Total Services Denied 2015: 4,038 (23.3%)
National Charges Submitted 2015: $ 6,668,864.09
National Charges Allowed 2015: $ 724,004.32
National Average (No Modifier) Fee Submitted 2015: $328.54
National Average (No Modifier) Fee Allowed 2015: $112.80


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Orthopedic surgery 9,077 52.3% $368.86 923 10.2%
Obstetrics/gynecology 1,473 8.5% $320.56 904 61.4%
General surgery 1,309 7.5% $585.47 232 17.7%
Physician assistant
(eff 5/92)
1,224 7.1% $211.94 693 56.6%
Urology 770 4.4% $298.69 40 5.2%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Inpatient hospital 12,071 69.6% $389.13 1,923 15.9%
Office 2,412 13.9% $326.47 1,240 51.4%
Outpatient hospital 2,402 13.8% $377.37 661 27.5%
Ambulatory surgical center 372 2.1% $620.87 144 38.7%
Emergency room - hospital 29 0.2% $1115.87 22 75.9%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
51 - Multiple Procedures 6,415 37.0% $372.27 388 6.0%
No Modifier 3,730 21.5% $328.54 1,813 48.6%
59 - Distinct Procedural Service 2,291 13.2% $577.47 446 19.5%
AS 1,134 6.5% $229.02 614 54.1%
RT - Right Side 669 3.9% $405.57 52 7.8%

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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06/24/2017 02:08:34 54.159.66.70

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