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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 that providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
The rules say that the Correct Coding Initiative was developed to promote correct coding and to control 
improper coding leading to inappropriate payment in Part B claims. The Coding Policy Manual also explains 
what is referred to as Column One/Column Two Correct Coding and Mutually Exclusive Edits. These are code 
pairs that should not be reported together. Medicare Administrative Contractors (MACs) subject all line items 
for the same beneficiary, same National Provider Identifier (NPI), and same date of service to National Correct 
Coding Initiative (NCCI) edits. The National Correct Coding Initiative (NCCI) File Formats continue to 
include a Correct Coding Modifier Indicator (CCMI) for the Column One / Column Two Correct Coding edit 
file. This indicator determines whether an NCCI Procedure to Procedure (PTP)-associated modifier causes the 
code pair to bypass the edit. You can find this rule in the Centers for Medicare and Medicaid Services, Internet 
Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Section 20.9. 
 
Medicare guidance says, CPT code 63048 Global days "ZZZ". Field Name & Description: 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." You can find this guidance in 
the July 2022 National Physician Fee Schedule Relative Value File and Medicare Claims Processing Manual 
Chapter 23 - Fee Schedule Administration and Coding Requirements, SEC- 50.6. 
 
Medicare guidance says An Add-on Code (AOC) is a Healthcare Common Procedure Coding System (HCPCS) 
/ Current Procedural Terminology (CPT) code that describes a service that is performed in conjunction with the primary service by the same practitioner. An AOC is rarely eligible for payment if its the only procedure 
reported by a practitioner. Add-on codes may be identified in three ways: 1 The add-on code is in the AOC file 
as a Type 1, Type 2, or Type 3 AOC (formerly displayed as Type I, Type II or Type III). 
2 On the Medicare Physician Fee Schedule Database, an AOC 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 AOC 
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. 
1. Type I - A Type 1 AOC has a limited number of identifiable primary procedure codes. The Change Request 
(CR) lists the Type 1 AOCs with their acceptable primary procedure codes. A Type 1 AOC, with one 
exception, is eligible for payment if one of the listed primary procedure codes is also eligible for payment to 
the same practitioner for the same patient on the same date of service. Claims processing contractors must 
adopt edits to assure that Type 1 AOCs are never paid unless a listed primary procedure code is also paid." You 
can find this guidance in the CMS.GOV Add-on Code Edits. Medicare guidance says "For Add-on code list 
63048 appropriate Primary Codes are 63045, 63046 and 63047. You can find this guidance in the Add-On 
Code Edits for 07012022 Implementation for Medicare 05172022 (ZIP) - Posted June 1, 2022. 
 
Medicare guidance says "The A/B MACs (A) must provide a listing of the required data elements, including a 
brief explanation to providers and suppliers. A/B MACs (A) must educate providers regarding the distinction 
between submissions which are not considered claims, but which are returned to provider (RTP) and 
submissions which are accepted by Medicare as claims for processing but are not paid. Claims may be accepted 
as filed by Medicare systems but may be rejected or denied. Unlike RTPs, rejections and denials are reflected 
on RAs. Denials are subject to appeal, since a denial is a payment determination. Rejections may be corrected 
and resubmitted." You can find this guidance in the Medicare Claims Processing Manual Chapter 1 - General 
Billing Requirements Section 70.2.3.2 and 80.3.1. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.