New HCPCS code C9899 (implanted prosthetic device, payable only for inpatients who do not have inpatient coverage) was effective for services furnished on or after January 1, 2009. HCPCS code C9899 is appropriate to be listed on the claim when the hospital has used an implanted prosthetic device for a Medicare inpatient who does not have coverage of inpatient services on the same date that the implanted device has been used.
A patient may not have Part A coverage when:
- The patient's Part A benefits are exhausted
- Their inpatient stay is determined to be medically unnecessary
- The patient is not eligible for Part A coverage
- The service is never covered under Part A
HCPCS code C9899 is only valid on bill type 12x. The implanted prosthetic device (C9899) should be further described in the "Remarks" section of the claim, either by narrative description or by the HCPCS device code (if one exists) to facilitate prompt payment and avoid the submission of a copy of the patient's medical record.
Is HCPCS code C9899 in your hospital's CDM? In order to have C9899 accurately listed on the claim, clinical staff needs to be aware when a patient does not have Medicare Part A coverage; billing staff should be aware when an implanted prosthetic device has been used on a patient. Are all of the steps in place to ensure your hospital gets the proper reimbursement they deserve?
Additional details can be found in Transmittal 1628, Change Request 6050 of November 3, 2008. The Medicare Claims Processing Manual (Pub. 100-04), Chapter 240 has been revised accordingly.