Wiki Interstim reimbursement for an asc, urinary incontinence

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Kleister

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Good Morning all,

Just a question, I wanted to see if anyone who bills the Interstim device is having trouble with payments from Aetna specifically? we are billing for stage I 64581 with L8680, and for stage II 64585, 64590, & L8688.

Thank you!:)
 
With the payers that we bill, the cpt codes covering Interstim are considered 'device intensive procedures' - so the allowed amounts for the cpt codes are (theoretically) high enough to cover the costs of the implants /devices ...we don't separately code the HCPCS codes for the tined leads, neurostimulator, etc. Some payers' coverage policies have specific diagnosis codes that are considered 'medically necessary.' And some payers' coverage policies have a list of 'conservative treatments' that must be fulfilled first before they will consider the Interstim medically necessary. What were the reasons for the denial?
 
thank you for your response. Each case is reviewed prior to even being scheduled at the facility for medical necessity to ensure the pt has satisfied all of the conservative measures first. It is being denied for not med nec, which does not make sense, and our contract rate is not high enough to cover the implant cost, so we cannot bill with just cpt,
 
One thing - the 64585 is removal of tined lead - you wouldn't do that in stage II - you would just implant the neurostimulator 64590 if the tined lead was already put it in stage I.
 
thank you, yes some pts have had the interstim for a while and the physician has removed and replaced the lead/ also generator/programmer and replaced, if it was non functioning.

We have had problems getting reimbursed for this and placing a new interstim also
 
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