Medicare ASC payment for CPT 33240

Payment When a Device Is Furnished With No Cost or With Full or Partial Credit

Effective January 1, 2008, Medicare pays ASCs a reduced amount for certain specified procedures when a specified replacement device is furnished without cost or for which either a partial or full credit is received (e.g., device recall). For specified procedure codes that include payment for a device, ASCs are required to include an FB modifier on the procedure code when a specified replacement device is furnished without cost or for which full credit is received. If the ASC receives a partial credit of 50 percent or more of the cost of the specified replacement device, the ASC is required to include the FC modifier on the procedure code. A single procedure code should not be submitted with both an FB and an FC modifier. The pricing determination related to the FB and FC modifiers is performed prior to the application of the multiple procedure payment reductions.

In order to report that a partial credit of 50 percent or more of the cost of a replacement device was received, ASCs have the option of either:

• Submitting the claim for the device replacement procedure to Medicare after the procedure’s performance but prior to manufacturer acknowledgement of credit for a replacement device, and subsequently contacting Medicare regarding a claims adjustment once the credit determination is made.
Or,

• Holding the claim for the device replacement procedure until a determination is made by the manufacturer on the partial credit and submitting the claim with the FC modifier appended to the implantation procedure HCPCS code if the partial credit is 50 percent or more of the cost of the replacement device. If choosing the first billing option, to request a claims adjustment once the credit determination is made.

ASCs should keep in mind that the initial Medicare payment for the procedure involving the replacement device is conditional and subject to adjustment.

FC Partial credit received for replaced device.

Pricing Example Before Full- or Partial-Credit Adjustment

This pricing example represents the surgical procedure as well as the implanted device.
Code Description Procedure Indicator Units Unadjusted Payment
33240 Implant ICD J8* 1 $19,984.99