“In the past, it has been postulated that a doctor had the option of using a fracture code or using E/M codes
to bill for fracture care. With the upcoming changes to E/M reimbursement, it would seem that billing using
E/M codes might make for sense for fracture care. Are there any thoughts on these changes upcoming for
2021?”
“We have billed CPT 11730 for all 10 nails using the appropriate toe modifiers. Anthem Blue Cross paid for five of the toes but is denying the other five. The denial comes back with CO-222 (Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.) Please advise.”
The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021
