We are implementing a new reimbursement policy for the CPT code for “unlisted procedure, lungs and pleura” that will go into effect April 21, 2018.
The new policy applies to our commercial plans, including employer-sponsored, self-funded and individual plans. We already have a similar policy in place for our Medicare Advantage plans.
Here are the details of the new policy:
- Policy statement: CPT code 32999 “Unlisted procedure, lungs and pleura” will always require clinical documentation to determine if the procedure is payable.
If the service was related to insertion of a catheter or creation of a pocket for post-operative pain management, the service will be bundled to the primary procedure.
Any other services will be considered on a case-by-case basis.
- Billing instructions: Submit clinical documentation describing the procedure.
- Reimbursement information: Unlisted code reimbursement for 32999, when payable, is at 65 percent of charges or equal to a comparable procedure with a listed CPT code, whichever is less. Excessive charges will be considered on an individual basis.