CMS: TIPs Not Reasonable or Necessary
- By admin aapc
- In CMS
- December 15, 2008
- Comments Off on CMS: TIPs Not Reasonable or Necessary
The Centers for Medicare & Medicaid Services (CMS) has issued a national coverage determination (NCD) ruling thermal intradiscal procedures (TIPs) not reasonable and necessary for the treatment of low back pain performed on Medicare beneficiaries.
Percutaneous TIPs involve the insertion of a catheter(s) or probe(s) in the spinal disc under radiologic or fluoroscopic guidance to produce or apply heat and/or disruption within the disc. Physicians perform TIPs to treat symptomatic patients with annular disruption of a contained herniated disc, to seal annular tears or fissures, or to destroy nociceptors.
Four CPT® codes identify TIPs performed within the annulus of the intervertebral disc:
- 22526 – Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level
- 22527 – Percutanious intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; one or more additional levels
- 0062T – Percutaneous intradiscal annuloplasty, any method except electrothermal, unilateral or bilateral including fluorscopic guidance; single level
- 0063T – Percutaneous intradiscal annuloplasty, any method except electrothermal, unilateral or bilateral including fluorscopic guidance; one or more additional levels
Effective for services performed on or after Sept. 29, 2008, Medicare will no longer reimburse codes 22526, 22527, 0062T, and 0063T for TIPs procedures.
Physicians, ambulatory surgical centers (ASCs), and hospitals are advised to provide an advanced beneficiary notice (ABN) to Medicare beneficiaries before performing non-covered services of this nature.
Percutaneous disc decompression or nucleoplasty procedures that do not use radio frequency or electrothermal energy (such as the disc decompression procedure or laser procedure) are not affected by this NCD.
Providers should submit code 0062T (and not 64999) for intradiscal biacuplasty (IDB) procedures, according to CMS guidance.
Continue to use the following CPT® codes for TIPs performed within the nucleus of the disc:
- 62287- Aspriation procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar
- 22899 – Unlisted procedure, spine
- 64999 – Unlisted procedure, nervous system
Include a clear description of the TIPs service in the narrative section of the claim when submitting code 22899 or 64999 as these codes suspend for review. CPT® code 62287 does not suspend for review.
Read Transmittal 97, CR 6291 and Transmittal 1646, CR 6291 for details and billing requirements. MLN Matters MM6291 is also available online.
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