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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
 
The rules say CMS.GOV Add-on Code Edits: An add-on code is a HCPCS/CPT code that describes a service 
that, with one exception (see CR7501 for details), is always performed in conjunction with another primary 
service. An add-on code with one exception is eligible for payment only if it is reported with an appropriate 
primary procedure performed by the same practitioner. An add-on code with one exception is never eligible for 
payment if it is the only procedure reported by a practitioner. 
Add-on codes may be identified in three ways: 
1. The code is listed in this CR or subsequent ones as a Type I, Type II, or Type III add-on code. 
2. On the Medicare Physician Fee Schedule Database an add-on code generally has a global surgery period of 
"ZZZ". 
3. In the CPT Manual an add-on code is designated by the symbol "+". The code descriptor of an add-on code 
generally includes phrases such as "each additional" or "(List separately in addition to primary procedure). 
"CMS has divided the add-on codes into three groups to distinguish the payment policy for each group. 
 
Type II - A Type II add-on code does not have a specific list of primary procedure codes. The CR lists the Type 
II add-on codes without any primary procedure codes. Claims processing contractors are encouraged to develop 
their own lists of primary procedure codes for this type of add-on codes. Like the Type I add-on codes, a Type 
II add-on code is eligible for payment if an acceptable primary procedure code as determined by the claims 
processing contractor is also eligible for payment to the same practitioner for the same patient on the same date 
of service. You can find this information in the CMS.GOV Add-on Code Edit. 
 
The rules say that Change Request 7501: The Internet Only Manual, Claims Processing Manual, Publication 
100-04, Chapter 12, Section 30.6.12(I) requires a provider to report CPT code 99292 (Critical care, evaluation 
and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in 
addition to code for primary service)) without its primary code CPT code 99291 (Critical care, evaluation and 
management of the critically ill or critically injured patient; first 30-74 minutes) if two or more physicians of 
the same specialty in a group practice provide critical care services to the same patient on the same date of service. For the same date of service only one physician of the same specialty in the group practice may report 
CPT code 99291 with or without CPT code 99292, and the other physician(s) must report their critical care 
services with CPT code 99292. Final Complete File of Add-on Code Edits for January 01, 2020, 
implementation for Medicare, Type I CPT Manual, HCPCS Manual, and/or CMS Policy defines all acceptable 
primary codes: For Add-on code 76937; appropriate Primary Codes Contractor Defined Primary Code(s). 
 
HCPCS 44955, Global Days ZZZ 
Medicare Claims Processing Manual, Chapter 23 Fee Schedule Administration and Coding Requirements, 50.6 
-Physician Fee Schedule Payment Policy Indicator File Record Layout: Field Item 16 Global Surgery, This 
field provides the postoperative time frames that apply to payment for each surgical procedure or another 
indicator that describes the applicability of the global concept to the service. ZZZ = Code related to another 
service and is always included in the global period of the other service. (Note: Physician work is associated 
with intra-service time and in some instances the post service time.). Reimbursement Policy CMS 1500, Add-
On Codes Policy: Add-on to Primary Code Relationship List; this table includes Add-on codes which will only 
be reimbursed when reported with the appropriate primary code. You can find the information in the 2022 
National Physician Fee Schedule Relative Value File Release. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.