S-Code Follow-up...........
Wil Haines
Description
Collection
Title:
S-Code Follow-up...........
Creator:
Wil Haines
Date:
12/21/2004
Text:
Evidently, based upon the out of the office replies that I received, many
folks have already left for the holidays. Anyway, there were two responses
to the original request (between the asteriks) and they are:
Reply 1.
All S-Codes codes are used the same as L-Codes. The S simply demarks codes
that are not covered by medicare but may be billed to other third party
insurances.
Reply 2.
In researching cranial remolding codes a few years back, I came across a
CMS document titled HCPCS Temporary Coding decisions for 2003 that said:
Types of temporary HCPCS codes: The S codes are used by the BCBSA
and the AHIP to report drugs, services and supplies for which there are no
national codes but for which codes are needed by the private sector to
implement policies, programs, or claims processing. They are for the purpose
of meeting the particular needs of the private sector. These codes are also
used by the Medicaid program, but they are not payable by Medicare.
The S1040 codes was listed for that year, but I have never seen the
rest of the codes you found. We have had inconsistent results in having
S1040 acknowledged and / or paid for by the privates.
So, my next question is, is anyone using any of the S Codes below or CPT
codes, such as: 97504 - Orthotic Training or 97520 - Prosthetic Training for
Medicaid or other 3rd party payors with any success? I'm still not sure
why S Codes were developed by CMS inasmuch that there are several L Codes
that are non-covered by Medicare, but are still listed as L Codes and are
often paid by agencies, such as Medicaid or other private carriers. This
seems confusing to me. There must be another reason. In particular, I
would like to know if anyone is having success with S0395 for Medicaid or
the private sector. Thanks again for your replies.
folks have already left for the holidays. Anyway, there were two responses
to the original request (between the asteriks) and they are:
Reply 1.
All S-Codes codes are used the same as L-Codes. The S simply demarks codes
that are not covered by medicare but may be billed to other third party
insurances.
Reply 2.
In researching cranial remolding codes a few years back, I came across a
CMS document titled HCPCS Temporary Coding decisions for 2003 that said:
Types of temporary HCPCS codes: The S codes are used by the BCBSA
and the AHIP to report drugs, services and supplies for which there are no
national codes but for which codes are needed by the private sector to
implement policies, programs, or claims processing. They are for the purpose
of meeting the particular needs of the private sector. These codes are also
used by the Medicaid program, but they are not payable by Medicare.
The S1040 codes was listed for that year, but I have never seen the
rest of the codes you found. We have had inconsistent results in having
S1040 acknowledged and / or paid for by the privates.
So, my next question is, is anyone using any of the S Codes below or CPT
codes, such as: 97504 - Orthotic Training or 97520 - Prosthetic Training for
Medicaid or other 3rd party payors with any success? I'm still not sure
why S Codes were developed by CMS inasmuch that there are several L Codes
that are non-covered by Medicare, but are still listed as L Codes and are
often paid by agencies, such as Medicaid or other private carriers. This
seems confusing to me. There must be another reason. In particular, I
would like to know if anyone is having success with S0395 for Medicaid or
the private sector. Thanks again for your replies.
Citation
Wil Haines, “S-Code Follow-up...........,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/224079.
