CPT Code 43281

Revised Bundling Guidelines for BCBS of North Carolina

Hernia repair (CPT 43280, CPT Code 43281, CPT 43332, CPT 43334, CPT 43336) is considered an incidental procedure when performed during the same operative session as bariatric surgery (CPT 43644, CPT 43645, CPT 43770, CPT 43775, CPT 43842, CPT 43843, CPT 43845, CPT 43846, CPT 43847). Modifiers 58, 59, 78 and 79 (or XE, XS, XP, XU) will not allow additional payment when appended to these codes. 

Chemotherapy – Evaluation and Management services will generally be denied when submitted on the same date of service as a chemotherapy administration code. If a significant, separately identifiable service is performed, modifier 25 is used. Office notes must document the significant, separately identifiable service. 

Obstetrical ultrasound: 

Ultrasound add-on codes indicating multiple gestation will be denied when the diagnosis code does not specify multiple gestation. 

First trimester obstetrical ultrasound (CPT 76801) is considered to be incidental to obstetrical ultrasound with first trimester fetal nuchal translucency measurement (CPT 76813) unless there is a separate medical necessity indication for CPT 76801

Office visit (CPT 99211) is considered mutually exclusive to CPT 95115-95117 (allergen immunotherapy) and not eligible for separate reimbursement. 

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