Medicare Procedure Codes

by Bob Przybylinski
(Chicago, Illinois)

I have to have some tests done and called Medicare to see if they cover them. I was told I need their procedure codes.


I've made numerous calls to the doctor, hospital and the billing dept's to get the codes but no one will give them to me. I again called Medicare but have hit a stone wall. Is there a book I could buy that lists the codes Medicare uses?

Thank you
Bob

Response:

There are books of codes you can buy but trying to figure out which ones a provider or hospital would use would be very difficult without their cooperation and guidance.

I can understand the provider can't give all of the specific procedure codes they would use before they have actually billed it. But they should by able to give you enough information for you to get an idea if Medicare will cover it.

You may have tried this already but it may be helpful if you can get the doctors office to pre-authorize the tests. For example when I've got to get a procedure or test done, the doctor and/or facility will do a pre-authorization and tell me how much I'll have to pay once they have scheduled the procedure.

If you still want to pursue getting the Medicare codes, you can find links and more information here on our Medical Billing Codes page.

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