Add-on Codes

IMPORTANT STATEMENT

The purpose of Reimbursement Policy is to document payment policy for medical and surgical services and supplies. Health care facilities, physicians and other health care providers are expected to exercise their medical judgment in providing the most appropriate care. Reimbursement policy is not intended to dictate medical practice.

Benefit and reimbursement determinations will be based on the applicable member and provider contract language. To the extent there are any conflicts between Reimbursement Policy and the member or provider contract language, the member or provider contract language will control.

Description

Some CPT and HCPCS codes are designated as add-on codes.  Add-on codes are always performed in conjunction with a primary procedure and describe additional intra-service work associated with the primary procedure.

Some add-on codes are only eligible with specific primary codes.

Add-on codes are usually identified with the statement "list separately in addition to code for primary procedure" and/or with a "+" symbol next to the code in the CPT manual.

Reimbursement Policy

Procedure codes designated as add-on codes are only to be reported in addition to the code for the associated primary procedure and are never to be reported as a stand-alone code. (1) (2)

Add-on codes not billed with the appropriate primary procedure code will be denied as a provider responsibility.

It is not necessary or appropriate to attach modifier -51 to report the add-on code(s).

When billed by professional providers, add-on codes are not subject to multiple procedure fee reductions as the relative value units (RVUs) assigned to these add-on codes have already been reduced to reflect their secondary procedure status.

References

1. American Medical Association.  “Introduction:  Add-on Codes”.  Current Procedural Terminology (CPT).  Chicago:  AMA Press
2. Centers for Medicare and Medicaid Services.  “General Correct Coding Policies – Add-on Codes”.  National Correct Coding Policy Manual for Part B Medicare Carriers.  Springfield:  National Technical Information Services (NTIS), p IA-21.

Cross References

Operating Microscope, Oregon Reimbursement Policy, Administrative, Policy No. 06

Modifier 51 - Multiple Procedure Fee Reduction, Oregon Reimbursement Policy, Administrative, Policy No. 10

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