CodeMap® Report 72270
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2018 ICD-10 Diagnosis Code Set Loaded     


10/01/2017 NCD Edits Loaded     


2017-D October DME Fee Schedule     


2017-A PEN Fee Schedule-no changes for rest of 2017     


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2017-D October APC Fee Schedule Updated     


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Q4 2017 CCI Edits Loaded     


Q4 2017 MUE Edits Loaded     


LCD Database Current Through 10/16/2017     

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72265
Quick jump to procedure code: Printer Friendly Version
72275

72270: Myelogphy 2/> spine regions

CPT® 72270: MYELOGRAPHY, 2 OR MORE REGIONS (EG, LUMBAR/THORACIC, CERVICAL/THORACIC, LUMBAR/CERVICAL, LUMBAR/THORACIC/CERVICAL), RADIOLOGICAL SUPERVISION AND INTERPRETATION


Short Description: Myelogphy 2/> spine regions

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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 Fee $129.20
26 Modifier $ 68.55
TC Modifier $ 60.65

2017 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2017 October Unadjusted OPPS Payment $449.68


*Based on National 2013 Medicare Part B submitted claims.
2017 APC Code: 5524
Level 4 Imaging without Contrast

2017 OPPS Status Indicator: Q2

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.
Limited claims data available for this procedure.
Percentage
ICD-10 Code
Description
Related DRG(s)
13.3%
M48.02
Spinal stenosis, cervical region
551-552
13.3%
M25.78
Osteophyte, vertebrae
551-552
6.7%
M51.36
Other intervertebral disc degeneration, lumbar region
551-552
6.7%
M47.817
Spondylosis without myelopathy or radiculopathy, lumbosacral region
551-552
6.7%
M51.37
Other intervertebral disc degeneration, lumbosacral region
551-552
6.7%
M54.16
Radiculopathy, lumbar region
551-552
6.7%
M50.21
Other cervical disc displacement, high cervical region
551-552
6.7%
M54.5
Low back pain
551-552
6.7%
M5022
This diagnosis code is no longer active.
6.7%
M47.812
Spondylosis without myelopathy or radiculopathy, cervical region
551-552

* 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.

72270 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 72270

CCI and MUE Edits*         Hide this section.

Column 1 CCI Edits for 72270
Denied Codes (1)
Effective
Modifier
Accepted (2)
00600 Anesth spine cord surgery
07/01/2002 No
00620 Anesth spine cord surgery
07/01/2002 No
00625 Anes spine tranthor w/o vent
01/01/2007 No
00626 Anes spine transthor w/vent
01/01/2007 No
00630 Anesth spine cord surgery
07/01/2002 No
01935 Anesth perc img dx sp proc
01/01/2008 No
01936 Anesth perc img tx sp proc
01/01/2008 No
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
62284 Injection for myelogram
01/01/2015 Yes
72240 Myelography neck spine
01/01/1996 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
72255 Myelography thoracic spine
01/01/1996 No
72265 Myelography l-s spine
01/01/1996 No
76000 Fluoroscope examination
06/05/2000 Yes
76001 Fluoroscope exam extensive
06/05/2000 Yes
77001 Fluoroguide for vein device
01/01/2011 Yes
77002 Needle localization by xray
01/01/2007 Yes
77003 Fluoroguide for spine inject
01/01/2007 Yes
99446 Interprof phone/online 5-10
01/01/2014 Yes
99447 Interprof phone/online 11-20
01/01/2014 Yes
99448 Interprof phone/online 21-30
01/01/2014 Yes
99449 Interprof phone/online 31/>
01/01/2014 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 72270.

(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 72270

Denied Codes (1)
Effective
Modifier
Accepted (2)
62302 Myelography lumbar injection
01/01/2015 Yes
62303 Myelography lumbar injection
01/01/2015 Yes
62304 Myelography lumbar injection
01/01/2015 Yes
62305 Myelography lumbar injection
01/01/2015 Yes
72125 Ct neck spine w/o dye
07/01/2014 Yes
72126 Ct neck spine w/dye
07/01/2014 Yes
72127 Ct neck spine w/o & w/dye
07/01/2014 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
72128 Ct chest spine w/o dye
07/01/2014 Yes
72129 Ct chest spine w/dye
07/01/2014 Yes
72130 Ct chest spine w/o & w/dye
07/01/2014 Yes
72131 Ct lumbar spine w/o dye
07/01/2014 Yes
72132 Ct lumbar spine w/dye
07/01/2014 Yes
72133 Ct lumbar spine w/o & w/dye
07/01/2014 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 72270.

(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 72270


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: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction 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.


   72270 Top 5 Ordering Providers National*
TED EDWARDS -HUNTSVILLE,AL 394
VADIM KOLESNIKOV -BROOKLYN,NY 26
ROBERT STEINBOCK -LOUISVILLE,KY 26
ANTHONY TOPPINS -DALLAS,TX 21
JEFFREY GREMMELS -CAPE GIRARDEAU,MO 15

   72270 Top 5 Ordering Organizations National*
SWDIC IMAGING CENTER PARTNERSHIP, LLP-TX 54

*Based on 2015 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 72270*         Hide this section.



Annual Procedures - Tests Performed / Denied


Total National Services (all modifiers) Submitted 2016: 1,408
Total Services Denied 2016: 251 (17.8%)
National Charges Submitted 2016: $ 914,819.28
National Charges Allowed 2016: $ 97,498.56
National Average (No Modifier) Fee Submitted 2016: $452.34
National Average (No Modifier) Fee Allowed 2016: $119.28
National Average (26) Fee Submitted 2016: $245.69
National Average (26) Fee Allowed 2016: $ 58.89
National Average (TC) Fee Submitted 2016: $6894.41
National Average (TC) Fee Allowed 2016: $ 60.01


Top 5 Performing Specialties 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 810 57.5% $272.18 182 22.5%
Pain Management
(eff. 1/1/02)
466 33.1% $429.67 37 7.9%
Independent Diagnostic Testing Facility
(IDTF)
(eff. 6/98)
63 4.5% $7112.04 3 4.8%
Physician assistant
(eff 5/92)
28 2.0% $290.36 7 25.0%
Interventional radiology
(eff 5/92)
16 1.1% $348.60 9 56.3%

Top 5 Places of Service 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Outpatient hospital 662 47.0% $248.07 124 18.7%
Office 569 40.4% $449.27 81 14.2%
Inpatient hospital 91 6.5% $244.55 29 31.9%
Independent Clinic 58 4.1% $7643.39 0 0.0%

Top 5 Modifiers Submitted 2016 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
26 - Professional Component 780 55.4% $245.69 163 20.9%
No Modifier 524 37.2% $452.34 71 13.5%
TC - Technical Component 65 4.6% $6894.41 5 7.7%
59 - Distinct Procedural Service 31 2.2% $603.68 9 29.0%
XU 4 0.3% $926.75 0 0.0%

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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10/21/2017 07:54:17 54.80.148.252

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