When reporting HCPCS code G0498, which facility is responsible for billing, and what services are included in its reimbursement?
HCPCS code G0498 should be reported by the infusion center that incurs the cost of the portable pump. Also included in the reimbursement for this HCPCS code is the patient return visit to either remove or return the portable pump to the infusion center. CMS instructed providers in Transmittal 3728 (March 3, 2017) to append modifier 52 (reduced services) when a portion of the work included in G0498 is not performed. Use of modifier 52 may reflect instances when the patient follow-up visit after completion of the prolonged infusion was not performed. This occurs when the patient turns in the pump to a location different than the center where the infusion was initiated. Go to https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3728CP.pdf to access CMS instructions in the transmittal.
This question was answered in our Coding Essentials for Infusion & Injection Therapy Services. For more hot topics relating to infusion services, please visit our store or call us at 1.800.252.1578, ext. 2.
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