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UCR 167:  Incident To - additional clarification; Not prescribed by a physician denial

October 20, 2023 

Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group.

1. I am a solo urologist newly working with a P.A. that I hired. What is the modifier for billing "incident to" or what is the mechanism for billing "incident to?" thank you

2.  This is in regards to Optilume, cat III code 0499T.  I know there will be a cat I code of 52284 that will take effect 1/1/2024, so we sent one claim in with the cat III code of 0499T.  Medicare denied it and the claim adjustment code given was PR-173.  Balance is the patient's responsibility due to the fact that 'service/equipment was not prescribed by a physician".  Does this mean we need to write a script for the drug on the balloon??  It just doesn't make sense to me......... 

Mark Painter and PRS Consulting

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