Wiki Connective tissue barrier implant(s) used in ortho procedures - provided to facility/surgeon and billed by the company that has the product????HELP!!

[gr8gal61]

I have been asked on how to bill for connective tissue barrier implants, used in surgical orthopedic surgeries that is provided from a supplier to the facility/surgeon and billed by the supplier??????

The intent is to supply the product to facilities/physicians and the physicians/surgeons will perform their medical procedure on the patient & utilize our product. I would then bill the health insurance companies for our product, connective tissue barrier implant. Does anyone have experience and or advice on this? I did read that CMS considers tissue adhesion barriers/implants as Assorted Devices, Implants, and Systems??? After reading the articles it doesn't seem there is confirmed, precise direction??

What type of entity can bill for these implants directly as it is our own product and is currently with FDA for approval? The company I am working with has a lab, diagnostic facility, medical entity, etc however I am confused on the supplier side ?

ANY & all help, suggestions would greatly be appreciated as my eyeballs are crossed from reviewing so much information because it is not a "cut & dry" type situation!

Thanks and be safe out there!

 

[thomas7331]

I don't think you will be able to bill for these - almost all payers calculate the costs of any surgical implant into the reimbursement rate that they pay to the facility for the procedure, and in fact for a lot of procedures (referred to as 'device dependent' procedures), payers will require the facility to include the charges for the implants on their claim form with the surgery and will deny the claim if it isn't.

Implants aren't like durable medical equipment that can be dispensed to the patient outside of the surgery. You'd need to invoice these to the facility where the implant is used and let them bill the insurance for their reimbursement.