June 28, 2018
Why do some insurance companies pay for the microscope (+69990) when we bill it for a lumbar discectomy (63030) and some don’t? I don’t get it. What recourse do we have if it isn’t paid?
First, CPT guidelines do not list 63030 as inclusive of the microscope so reporting 63030 and +69990 together is accurate per the AMA’s CPT coding rules. That said, Medicare has a National Correct Coding Initiative (NCCI) edit preventing payment for +69990 when billed with 63030 (and many other laminectomy codes). This is Medicare’s payment rule. Some non-Medicare payors follow this NCCI bundling edit and also will not pay. On the other hand, some non-Medicare payors don’t follow this edit and do reimburse +69990 when reported with 63030. If you are contracted with the payor who does not reimburse +69990, with 63030, then you likely don’t have much recourse because you are contractually obligated to follow their payment rules.
*This response is based on the best information available as of 06/28/18.