Reimbursement Policy Update: Medical Recalls
(Policy 06-111 — effective 11/01/2018)
In applicable circumstances, the appropriate modifier, condition code or value code (identified below) should be used to identify a medically recalled item. This will assist Empire BlueCross BlueShield HealthPlus in identifying medically recalled items and support correct coding guidelines.
Applicable condition codes are 49 and 50. Condition code 49 signifies products replaced within the product lifecycle due to the product not functioning properly, and condition code 50 is used for product replacement for known recall of a product.
When a credit or cost reduction is received by the provider for the replacement device, applicable modifiers are FB and FC. Modifier FB is used when items are provided without cost to the provider, supplier or practitioner, and modifier FC is used when a partial credit is received by the provider, supplier or practitioner for the replacement device.
Note: In circumstances where we have reimbursed the provider for repair or replacement of items or procedures related to items due to a medical recall, we are entitled to recoup or recover fees from the manufacturer and/or distributor as applicable. In circumstances where we have reimbursed the provider the full or partial cost of a replaced device and the provider received a full or partial credit for the device, we are entitled to recoup or recover fees from the provider.
Please refer to CMS and/or your state’s guidelines, and the Medical Recalls reimbursement policy for additional details at www.empireblue.com/nymedicaiddoc.
August 2018 Empire Provider Newsletter