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28294
Quick jump to procedure code: Printer Friendly Version
28297

CPT® 28296: CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; WITH METATARSAL OSTEOTOMY (EG, MITCHELL, CHEVRON, OR CONCENTRIC TYPE PROCEDURES)

Short Description: Correction of bunion

--

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
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

2016 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$739.13
$538.14

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 JulyUnadjusted OPPS Payment $2395.59
2016 July Unadjusted ASC Payment $1339.58


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5122
Level 2 Musculoskeletal Procedures

2016 OPPS Status Indicator: T

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
25.6% 735.4    Other hammer toe (acquired) M20.40   Other hammer toe(s) (acquired), unspecified foot
22.8% 735.0    Hallux valgus (acquired) M20.10   Hallux valgus (acquired), unspecified foot
8.7% 729.5    Pain in limb M79.609   Pain in unspecified limb
7.2% 727.1    Bunion M20.10   Hallux valgus (acquired), unspecified foot
3.2% 718.47    Contracture of joint, ankle and foot M24.573   Contracture, unspecified ankle
OR:
M24.576   Contracture, unspecified foot
3.0% 735.8    Other acquired deformities of toe M20.5X9   Other deformities of toe(s) (acquired), unspecified foot
2.2% 726.91    Exostosis of unspecified site M25.70   Osteophyte, unspecified joint
1.8% 355.6    Lesion of plantar nerve G57.60   Lesion of plantar nerve, unspecified lower limb
1.6% 754.52    Metatarsus primus varus Q66.2   Congenital metatarsus (primus) varus
1.4% 726.70    Enthesopathy of ankle and tarsus, unspecified M76.899   Other specified enthesopathies of unspecified lower limb, excluding foot
OR:
M77.40   Metatarsalgia, unspecified foot

* 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.

28296 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

CCI Edits for 28296
Denied Codes (1)
Effective
Modifier
Accepted (2)
11010 Debride skin at fx site
01/01/1998 Yes
11011 Debride skin musc at fx site
01/01/1998 Yes
11012 Deb skin bone at fx site
01/01/1998 Yes
28289 Repair hallux rigidus
06/05/2000 Yes
01470 Anesth lower leg surgery
07/01/2002 No
0213T Njx paravert w/us cer/thor
07/01/2010 No
0216T Njx paravert w/us lumb/sac
07/01/2010 No
0228T Njx tfrml eprl w/us cer/thor
10/01/2010 No
0230T Njx tfrml eprl w/us lumb/sac
10/01/2010 No
11420 Exc h-f-nk-sp b9+marg 0.5/<
01/01/1996 Yes
11421 Exc h-f-nk-sp b9+marg 0.6-1
01/01/1996 Yes
11422 Exc h-f-nk-sp b9+marg 1.1-2
01/01/1996 Yes
11423 Exc h-f-nk-sp b9+marg 2.1-3
01/01/1996 Yes
11424 Exc h-f-nk-sp b9+marg 3.1-4
01/01/1996 Yes
11730 Removal of nail plate
01/01/1996 Yes
11750 Removal of nail bed
01/01/1996 Yes
12001 Rpr s/n/ax/gen/trnk 2.5cm/<
10/01/2012 Yes
12002 Rpr s/n/ax/gen/trnk2.6-7.5cm
10/01/2012 Yes
12004 Rpr s/n/ax/gen/trk7.6-12.5cm
10/01/2012 Yes
12005 Rpr s/n/a/gen/trk12.6-20.0cm
10/01/2012 Yes
12006 Rpr s/n/a/gen/trk20.1-30.0cm
10/01/2012 Yes
12007 Rpr s/n/ax/gen/trnk >30.0 cm
10/01/2012 Yes
12011 Rpr f/e/e/n/l/m 2.5 cm/<
10/01/2012 Yes
12013 Rpr f/e/e/n/l/m 2.6-5.0 cm
10/01/2012 Yes
12014 Rpr f/e/e/n/l/m 5.1-7.5 cm
10/01/2012 Yes
12015 Rpr f/e/e/n/l/m 7.6-12.5 cm
10/01/2012 Yes
12016 Rpr fe/e/en/l/m 12.6-20.0 cm
10/01/2012 Yes
12017 Rpr fe/e/en/l/m 20.1-30.0 cm
10/01/2012 Yes
12018 Rpr f/e/e/n/l/m >30.0 cm
10/01/2012 Yes
12020 Closure of split wound
10/01/2012 Yes
12021 Closure of split wound
10/01/2012 Yes
12031 Intmd rpr s/a/t/ext 2.5 cm/<
10/01/2012 Yes
12032 Intmd rpr s/a/t/ext 2.6-7.5
10/01/2012 Yes
12034 Intmd rpr s/tr/ext 7.6-12.5
10/01/2012 Yes
12035 Intmd rpr s/a/t/ext 12.6-20
10/01/2012 Yes
12036 Intmd rpr s/a/t/ext 20.1-30
10/01/2012 Yes
12037 Intmd rpr s/tr/ext >30.0 cm
10/01/2012 Yes
12041 Intmd rpr n-hf/genit 2.5cm/<
10/01/2012 Yes
12042 Intmd rpr n-hf/genit2.6-7.5
10/01/2012 Yes
12044 Intmd rpr n-hf/genit7.6-12.5
10/01/2012 Yes
12045 Intmd rpr n-hf/genit12.6-20
10/01/2012 Yes
12046 Intmd rpr n-hf/genit20.1-30
10/01/2012 Yes
12047 Intmd rpr n-hf/genit >30.0cm
10/01/2012 Yes
12051 Intmd rpr face/mm 2.5 cm/<
10/01/2012 Yes
12052 Intmd rpr face/mm 2.6-5.0 cm
10/01/2012 Yes
12053 Intmd rpr face/mm 5.1-7.5 cm
10/01/2012 Yes
12054 Intmd rpr face/mm 7.6-12.5cm
10/01/2012 Yes
12055 Intmd rpr face/mm 12.6-20 cm
10/01/2012 Yes
12056 Intmd rpr face/mm 20.1-30.0
10/01/2012 Yes
12057 Intmd rpr face/mm >30.0 cm
10/01/2012 Yes
13100 Cmplx rpr trunk 1.1-2.5 cm
10/01/2012 Yes
13101 Cmplx rpr trunk 2.6-7.5 cm
10/01/2012 Yes
13102 Cmplx rpr trunk addl 5cm/<
10/01/2012 Yes
13120 Cmplx rpr s/a/l 1.1-2.5 cm
10/01/2012 Yes
13121 Cmplx rpr s/a/l 2.6-7.5 cm
10/01/2012 Yes
13122 Cmplx rpr s/a/l addl 5 cm/>
10/01/2012 Yes
13131 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13132 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13133 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13151 Cmplx rpr e/n/e/l 1.1-2.5 cm
10/01/2012 Yes
13152 Cmplx rpr e/n/e/l 2.6-7.5 cm
10/01/2012 Yes
13153 Cmplx rpr e/n/e/l addl 5cm/<
10/01/2012 Yes
14040 Tis trnfr f/c/c/m/n/a/g/h/f
07/01/2001 Yes
14041 Tis trnfr f/c/c/m/n/a/g/h/f
07/01/2001 Yes
20527 Inj dupuytren cord w/enzyme
01/01/2012 Yes
20550 Inj tendon sheath/ligament
01/01/1996 Yes
20551 Inj tendon origin/insertion
07/01/2002 Yes
20552 Inj trigger point 1/2 muscl
07/01/2002 Yes
20553 Inject trigger points 3/>
07/01/2002 Yes
20650 Insert and remove bone pin
07/01/2001 Yes
20690 Apply bone fixation device
01/01/2002 Yes
28010 Incision of toe tendon
01/01/1996 Yes
28011 Incision of toe tendons
01/01/1996 Yes
28022 Exploration of foot joint
01/01/1996 Yes
28024 Exploration of toe joint
01/01/1996 Yes
28052 Biopsy of foot joint lining
01/01/1996 Yes
28054 Biopsy of toe joint lining
01/01/1996 Yes
28072 Removal of foot joint lining
01/01/1996 Yes
28080 Removal of foot lesion
07/01/1999 Yes
28090 Removal of foot lesion
01/01/1996 Yes
28092 Removal of toe lesions
01/01/1996 Yes
28104 Removal of foot lesion
01/01/1996 Yes
28108 Removal of toe lesions
01/01/1996 Yes
28122 Partial removal of foot bone
01/01/1996 Yes
28124 Partial removal of toe
01/01/1996 Yes
28126 Partial removal of toe
01/01/1996 Yes
28150 Removal of toe
01/01/1996 Yes
28200 Repair of foot tendon
04/01/2011 Yes
28208 Repair of foot tendon
04/01/2011 Yes
28234 Incision of foot tendon
01/01/1996 Yes
28240 Release of big toe
01/01/1996 Yes
28270 Release of foot contracture
01/01/1996 Yes
28285 Repair of hammertoe
01/01/1996 Yes
28288 Partial removal of foot bone
10/01/2008 Yes
28290 Correction of bunion
01/01/1996 Yes
28292 Correction of bunion
01/01/1996 Yes
28298 Correction of bunion
01/01/1996 Yes
28306 Incision of metatarsal
10/01/2008 Yes
28307 Incision of metatarsal
01/01/1996 Yes
28310 Revision of big toe
10/01/2008 Yes
28315 Removal of sesamoid bone
10/01/2008 Yes
28476 Treat metatarsal fracture
07/01/2001 Yes
28485 Treat metatarsal fracture
01/01/1999 Yes
28645 Repair toe dislocation
01/01/1996 Yes
29405 Apply short leg cast
07/01/1999 Yes
29425 Apply short leg cast
01/01/1996 Yes
29515 Application lower leg splint
07/01/1999 Yes
29540 Strapping of ankle and/or ft
01/01/2003 Yes
29550 Strapping of toes
10/01/2010 Yes
36000 Place needle in vein
10/01/2002 Yes
36400 Bl draw < 3 yrs fem/jugular
04/01/2009 Yes
36405 Bl draw <3 yrs scalp vein
04/01/2009 Yes
36406 Bl draw <3 yrs other vein
04/01/2009 Yes
36410 Non-routine bl draw 3/> yrs
10/01/2002 Yes
36420 Vein access cutdown < 1 yr
04/01/2009 Yes
36425 Vein access cutdown > 1 yr
04/01/2009 Yes
36430 Blood transfusion service
04/01/2009 Yes
36440 Bl push transfuse 2 yr/<
04/01/2009 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
36600 Withdrawal of arterial blood
04/01/2009 Yes
36640 Insertion catheter artery
04/01/2009 Yes
43752 Nasal/orogastric w/tube plmt
04/01/2009 Yes
51701 Insert bladder catheter
10/01/2007 Yes
51702 Insert temp bladder cath
10/01/2007 Yes
51703 Insert bladder cath complex
10/01/2007 Yes
62310 Inject spine cerv/thoracic
04/01/2009 No
62311 Inject spine lumbar/sacral
04/01/2009 No
62318 Inject spine w/cath crv/thrc
10/01/2002 No
62319 Inject spine w/cath lmb/scrl
10/01/2002 No
64400 N block inj trigeminal
04/01/2009 No
64402 N block inj facial
04/01/2009 No
64405 N block inj occipital
04/01/2009 No
64408 N block inj vagus
04/01/2009 No
64410 N block inj phrenic
04/01/2009 No
64413 N block inj cervical plexus
04/01/2009 No
64415 N block inj brachial plexus
10/01/2002 No
64416 N block cont infuse b plex
01/01/2003 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
64417 N block inj axillary
10/01/2002 No
64418 N block inj suprascapular
04/01/2009 No
64420 N block inj intercost sng
04/01/2009 No
64421 N block inj intercost mlt
04/01/2009 No
64425 N block inj ilio-ing/hypogi
04/01/2009 No
64430 N block inj pudendal
04/01/2009 No
64435 N block inj paracervical
04/01/2009 No
64445 N block inj sciatic sng
04/01/2009 No
64446 N blk inj sciatic cont inf
04/01/2009 No
64447 N block inj fem single
04/01/2009 No
64448 N block inj fem cont inf
04/01/2009 No
64449 N block inj lumbar plexus
04/01/2009 No
64450 N block other peripheral
10/01/2002 Yes
64455 N block inj plantar digit
10/01/2009 Yes
64461 Pvb thoracic single inj site
01/01/2016 No
64463 Pvb thoracic cont infusion
01/01/2016 No
64479 Inj foramen epidural c/t
04/01/2009 No
64483 Inj foramen epidural l/s
04/01/2009 No
64486 Tap block unil by injection
01/01/2015 No
64487 Tap block uni by infusion
01/01/2015 No
64488 Tap block bi injection
01/01/2015 No
64489 Tap block bi by infusion
01/01/2015 No
64490 Inj paravert f jnt c/t 1 lev
01/01/2010 No
64493 Inj paravert f jnt l/s 1 lev
01/01/2010 No
64505 N block spenopalatine gangl
04/01/2009 No
64508 N block carotid sinus s/p
04/01/2009 No
64510 N block stellate ganglion
04/01/2009 No
64517 N block inj hypogas plxs
04/01/2009 No
64520 N block lumbar/thoracic
04/01/2009 No
64530 N block inj celiac pelus
04/01/2009 No
69990 Microsurgery add-on
06/05/2000 No
76000 Fluoroscope examination
01/01/1999 Yes
76001 Fluoroscope exam extensive
10/01/2009 Yes
77001 Fluoroguide for vein device
01/01/2011 Yes
77002 Needle localization by xray
01/01/2011 Yes
92012 Eye exam establish patient
04/01/2014 Yes
92014 Eye exam&tx estab pt 1/>vst
04/01/2014 Yes
93000 Electrocardiogram complete
04/01/2009 Yes
93005 Electrocardiogram tracing
04/01/2009 Yes
93010 Electrocardiogram report
04/01/2009 Yes
93040 Rhythm ecg with report
04/01/2009 Yes
93041 Rhythm ecg tracing
04/01/2009 Yes
93042 Rhythm ecg report
04/01/2009 Yes
93318 Echo transesophageal intraop
04/01/2009 Yes
93355 Echo transesophageal (tee)
01/01/2015 Yes
94002 Vent mgmt inpat init day
04/01/2009 Yes
94200 Lung function test (mbc/mvv)
04/01/2009 Yes
94250 Expired gas collection
04/01/2009 Yes
94680 Exhaled air analysis o2
04/01/2009 Yes
94681 Exhaled air analysis o2/co2
04/01/2009 Yes
94690 Exhaled air analysis
04/01/2009 Yes
94770 Exhaled carbon dioxide test
04/01/2009 Yes
95812 Eeg 41-60 minutes
04/01/2009 Yes
95813 Eeg over 1 hour
04/01/2009 Yes
95816 Eeg awake and drowsy
04/01/2009 Yes
95819 Eeg awake and asleep
04/01/2009 Yes
95822 Eeg coma or sleep only
04/01/2009 Yes
95829 Surgery electrocorticogram
04/01/2009 Yes
95955 Eeg during surgery
04/01/2009 Yes
96360 Hydration iv infusion init
01/01/2009 Yes
96361 Hydrate iv infusion add-on
04/01/2016 Yes
96365 Ther/proph/diag iv inf init
01/01/2009 Yes
96366 Ther/proph/diag iv inf addon
04/01/2016 Yes
96367 Tx/proph/dg addl seq iv inf
04/01/2016 Yes
96368 Ther/diag concurrent inf
04/01/2016 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
04/01/2009 Yes
99148 Mod sed diff phys/qhp<5 yrs
10/01/2009 No
99149 Mod sed diff phys/qhp 5/>yrs
10/01/2009 No
99150 Mod sed diff phys/qhp add on
10/01/2009 No
99211 Office/outpatient visit est
07/01/2013 Yes
99212 Office/outpatient visit est
07/01/2013 Yes
99213 Office/outpatient visit est
07/01/2013 Yes
99214 Office/outpatient visit est
07/01/2013 Yes
99215 Office/outpatient visit est
07/01/2013 Yes
99217 Observation care discharge
07/01/2013 Yes
99218 Initial observation care
07/01/2013 Yes
99219 Initial observation care
07/01/2013 Yes
99220 Initial observation care
07/01/2013 Yes
99221 Initial hospital care
07/01/2013 Yes
99222 Initial hospital care
07/01/2013 Yes
99223 Initial hospital care
07/01/2013 Yes
99231 Subsequent hospital care
07/01/2013 Yes
99232 Subsequent hospital care
07/01/2013 Yes
99233 Subsequent hospital care
07/01/2013 Yes
99234 Observ/hosp same date
07/01/2013 Yes
99235 Observ/hosp same date
07/01/2013 Yes
99236 Observ/hosp same date
07/01/2013 Yes
99238 Hospital discharge day
07/01/2013 Yes
99239 Hospital discharge day
07/01/2013 Yes
99241 Office consultation
07/01/2013 Yes
99242 Office consultation
07/01/2013 Yes
99243 Office consultation
07/01/2013 Yes
99244 Office consultation
07/01/2013 Yes
99245 Office consultation
07/01/2013 Yes
99251 Inpatient consultation
07/01/2013 Yes
99252 Inpatient consultation
07/01/2013 Yes
99253 Inpatient consultation
07/01/2013 Yes
99254 Inpatient consultation
07/01/2013 Yes
99255 Inpatient consultation
07/01/2013 Yes
99291 Critical care first hour
07/01/2013 Yes
99292 Critical care addl 30 min
07/01/2013 Yes
99304 Nursing facility care init
07/01/2013 Yes
99305 Nursing facility care init
07/01/2013 Yes
99306 Nursing facility care init
07/01/2013 Yes
99307 Nursing fac care subseq
07/01/2013 Yes
99308 Nursing fac care subseq
07/01/2013 Yes
99309 Nursing fac care subseq
07/01/2013 Yes
99310 Nursing fac care subseq
07/01/2013 Yes
99315 Nursing fac discharge day
07/01/2013 Yes
99316 Nursing fac discharge day
07/01/2013 Yes
99334 Domicil/r-home visit est pat
07/01/2013 Yes
99335 Domicil/r-home visit est pat
07/01/2013 Yes
99336 Domicil/r-home visit est pat
07/01/2013 Yes
99337 Domicil/r-home visit est pat
07/01/2013 Yes
99347 Home visit est patient
07/01/2013 Yes
99348 Home visit est patient
07/01/2013 Yes
99349 Home visit est patient
07/01/2013 Yes
99350 Home visit est patient
07/01/2013 Yes
99374 Home health care supervision
07/01/2013 Yes
99375 Home health care supervision
07/01/2013 Yes
99377 Hospice care supervision
07/01/2013 Yes
99378 Hospice care supervision
07/01/2013 Yes
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
99495 Trans care mgmt 14 day disch
01/01/2014 No
99496 Trans care mgmt 7 day disch
01/01/2014 No
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G0471 Ven blood coll snf/hha
07/01/2015 Yes
J0670 Inj mepivacaine hcl/10 ml
07/01/2010 Yes
J2001 Lidocaine injection
07/01/2004 Yes
28297 Correction of bunion
10/01/1996 Yes
28299 Correction of bunion
04/01/2002 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 28296.

(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 28296


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: CMS Policy CMS Policy 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.


   28296 Top 5 Ordering Providers National*
TAE SONG -REDDING,CA 35
GEORGE MERRITT -TALLAHASSEE,FL 32
NEAL FRANKEL -CHICAGO,IL 30
QUINN FAURIA -STUDIO CITY,CA 29
DAVID BUCHAN -LANCASTER,OH 29

   28296 Top 5 Ordering Organizations National*
INTERNATIONAL CENTER FOR FOOT & ANKLE SURGERY-GA 42
NORTH FLORIDA REGIONAL FREESTANDING SURGERY CENTER LP-FL 40
SILICON VALLEY SURGERY CENTER, LP-CA 36
FIFTH AVENUE SURGERY CENTER, LLC-NY 33
AMBULATORY ANKLE & FOOT CENTER OF FLORIDA INC-FL 32

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



   Medicare Part B Utilization Data for 28296*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 24,157
Total Services Denied 2014: 2,671 (11.1%)
National Charges Submitted 2014: $ 72,545,974.00
National Charges Allowed 2014: $ 16,095,560.00
National Average (No Modifier) Fee Submitted 2014: $2291.16
National Average (No Modifier) Fee Allowed 2014: $686.89


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Podiatry 14,728 61.0% $1692.24 1,914 13.0%
Ambulatory surgical center
(formerly miscellaneous)
6,535 27.1% $6334.08 435 6.7%
Orthopedic surgery 2,232 9.2% $2365.86 233 10.4%
Physician assistant
(eff 5/92)
547 2.3% $1311.65 61 11.2%
Nurse practitioner 76 0.3% $1348.98 23 30.3%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Ambulatory surgical center 13,580 56.2% $3973.37 1,343 9.9%
Outpatient hospital 9,646 39.9% $1763.09 1,158 12.0%
Office 668 2.8% $1727.70 128 19.2%
Inpatient hospital 228 0.9% $1632.94 31 13.6%
Emergency room - hospital 16 0.1% $1794.87 2 12.5%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
RT - Right Side 7,339 30.4% $3088.12 725 9.9%
LT - Left Side 6,406 26.5% $3124.70 646 10.1%
No Modifier 2,948 12.2% $2291.19 381 12.9%
T5 1,913 7.9% $4398.76 144 7.5%
TA 1,734 7.2% $4167.95 146 8.4%

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*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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07/26/2016 03:23:07 54.81.190.231

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