Fluoroscopy for positioning or intraoperative localization is an eligible service when it is performed by a doctor other than the operating surgeon, his associate or his assistant. Separate payment can be made under code 76000 or 76001, as appropriate. It will be necessary for the provider to submit medical records and/or additional documentation to determine coverage in this situation.

When an itemized charge for this service is reported by the operating surgeon, his associate or his assistant, the charges should be combined and reimbursed under the appropriate code for the surgical procedure reported.

Payment may be made for "paired matrix" or "spot films" in addition to the fluoroscopic procedure. When reported, the service should be reimbursed as a radiological examination using the appropriate procedure code for the actual imaging study performed.

Fluoroscopy without film provides no lasting documentation for inclusion in the patient's records. A service of this type (e.g., tube check for patency) is not eligible. When reported, the procedure should be denied as not covered. A participating, preferred, or network provider cannot bill the member for the denied service.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.