Does Medicare cover paracentisis once a week at outpatient hospital?

A: Paracentesis (CPT code 40982) procedure falls the outpatient surgery exclusion below. In order to be excluded, these services MUST be performed in a hospital operating room setting on an outpatient basis.

When reviewing the consolidated billing spread sheet it is important to note that this category lists inclusions not exclusions so any of the procedures listed would be the financial responsibility of the SNF even if performed in a hospital operating room setting. In reviewing the spreadsheet, you will note that CPT code 49082 is not found, meaning it would not be the financial responsibility of the SNF when performed in a hospital operating room setting. When performed in any other setting the exclusion would not apply; therefore, it would be the financial responsibility of the SNF.

Outpatient Surgery and Related Procedures– INCLUSION (see note below) Note: Inclusions, rather than exclusions, are given in this one case, because of the great number of surgery procedures that are excluded and can only be safely performed in a hospital operating room setting. It is easier to automate edits around the much shorter list of inclusions under this category, representing minor procedures that can be performed in the SNF itself. The physician’s service itself may be excluded for the codes listed (identified in the Carrier A/B MAC files) in this section, however, when these codes are billed by the hospital they are for the technical/facility charge and are not excluded.