Joint replacement implants (HCPCS C1776) — Payment and coding interpretation
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Defines Blue KC's payment and coding interpretation for joint replacement device reporting (HCPCS C1776) for facility ambulatory surgery and related commercial and Medicare Advantage lines of business.
No material clinical or coverage changes in this revision.
Coverage and Coding Rules for Joint Devices
Coverage and coding rules for joint devices
Covered when all of the following coding and member/benefit conditions are met:
ALL of the following
- Apply CMS MUE of 10 units to HCPCS C1776; the MUE of 10 may be used for multiple joint replacements in the feet and hands; limit to 1 unit for shoulder, knee, or hip replacements.
- Contact Blue KC Provider Hotlines to confirm coverage and medical necessity determinations prior to or at time of service as coverage is determined by date of service, member eligibility, benefits, and provider agreement.
ALL of the following
HCPCS Codes and Medically Unlikely Edit (MUE)
Provider Guidance and Confirmation Steps
Confirm coverage and medical necessity with Blue KC prior to billing
Contact Blue KC Provider Hotlines to confirm whether a service is eligible for coverage and to verify medical necessity for the specific date of service; final coverage depends on member eligibility, benefits, and the provider service agreement.
- Commercial lines: 816-395-3929
- Affordable Care Act: 866-859-3822
- Blue Medicare Advantage: 866-508-7140
Definitions
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