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pvanwalleghem
#1 Posted : Monday, July 23, 2018 1:34:36 PM(UTC)
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pvanwalleghem

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How do I bill 3-d imaging with interpretation & reporting to Blue cross or Medicare, for sleep apnea? Do I bill more then one code? Is the diagnosis code the same? Do I need a modifier?
courtneydsnow
#2 Posted : Tuesday, July 24, 2018 7:40:19 AM(UTC)
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courtneydsnow

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Hi

Great question. Many practices use 76376 for the rendering with interpretation & reporting part of the CBCT. For the CBCT itself, many practices use CPT 70486. Here are the full descriptions of 70486, 76376, and 76377 below:

70486 - Computed tomography, maxillofacial area; without contrast material

76376 - 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image post-processing on an independent workstation

76377 - 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation

**The codes 76376 and 76377 are both used to report 3D rendering postprocessing. The difference between them is 76376 does not require postprocessing on an independent workstation whereas 76377 does require the use of an independent workstation.

As for billing particular insurers for these imaging services, we do find that some insurers (i.e. medicare) will require that you are actually accredited through a radiology program in order to reimburse providers for what they consider “advanced imaging”.

Also, many insurers will require pre-authorization for these “advanced imaging” services as well.

And just a heads up, while CBCT is often covered for surgical & pre-surgical cases, you may run into medical insurers that say CBCT is not medically necessary for diagnosis or treatment of OSA.

Hope this helps!
Guest
#3 Posted : Wednesday, March 6, 2019 4:28:30 PM(UTC)
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Guest

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Courntey,

Do you have any idea what the PPO insurance companies are typically paying for the oral appliance(E0486)?

A company reached out to me about becoming in network as they typically get their doctors $4,500 per case as an in network provider.
courtneydsnow
#4 Posted : Thursday, March 7, 2019 12:57:36 PM(UTC)
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courtneydsnow

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Hi Guest!

Great question. From polls from our clients and records from our medical billing service, the average allowed amount for E0486 across the nation is approx $3000. (so 4500 is a great offer!). Some insurers allow as low as around $1000 for E0486, while some as high as $5-6,000, although that higher end is fairly rare.

Hope this helps!
Sabrina
#5 Posted : Friday, March 15, 2019 11:34:41 AM(UTC)
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Guest

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Are the numbers from you poll based off of in network rates or out of network rates?





Originally Posted by: courtneydsnow Go to Quoted Post
Hi Guest!

Great question. From polls from our clients and records from our medical billing service, the average allowed amount for E0486 across the nation is approx $3000. (so 4500 is a great offer!). Some insurers allow as low as around $1000 for E0486, while some as high as $5-6,000, although that higher end is fairly rare.

Hope this helps!


courtneydsnow
#6 Posted : Tuesday, March 19, 2019 7:35:03 AM(UTC)
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courtneydsnow

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Hi Sabrina!

The majority of the figures are out of network, but there is a small percentage of in-network figures that go into that.
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