Payment for FCE
Mon, 04/21/2008 - 5:41pm
I just got off the phone with an adjuster in Oregon and was told that the CPT code 97750 was denied for my FCE because it is a code for ROM evaluation ONLY. They told me to use 99196 for less than 2 hours, 99197 for 2-4 hours, and 99198 for 4+ hours. This was after worming it out of them but that is another story. They only wanted to pay $300 for it too but I talked them into letting me rebill it.
What is the CPT code to bill for an FCE and does anyone know what these other codes are? Any light shed on the subject would be much appreciated.
Thanks!
Jon
Jon,
I just checked with my billing department (12+ clerks) and we were unable to identify a code that matches up with 99196-8 anywhere in the CPT codebook. They also checked online for something they may have missed and still came up blank. As you are probably aware, the 97750 code is for Physical Performance Testing, in 15 minute increments. The 2008 CPT book continues the statement that this code is for musculoskeletal exams and evaluation of functional capacity (with written report). The 97750 code is what I use for FCE billing (x16 units). As you are probably aware, some insurance companies have all kinds of stipulations designed to help deny claims-like not accepting more than one unit per day or having caps on only a few per week/etc. Your best bet in a situation like this, in my opinion, is to have a billing agreement with them where when you do an FCE they agree to pay you a flat fee without any hassle. If they don't agree, you know where you stand with them and can deny to do them summarily, if you choose.