Wiki Iovera - insurance coverage

[suhadolnike]

I was hoping someone would have any insight into the new IOVERA procedure. The Physicians I work for are being approached by Iovera Reps stating this is the new procedure to adopt - cryoanalgesia. This is to be done several days prior to a TKA and supposedly provides long term post-op pain relief. They claim it is covered by many major insurance companies not including Anthem. Has anyone been billing this and having success with receiving payment? Did you have to submit specific documentation to ensure payment? Any information on the topic is helpful.

 

[jkyles]

Sorry, I have yet to see a policy that covers cryoneurolysis for that purpose. The reps may be under the impression that the service is covered because there are codes that could apply to the service (64640 and 64624).

Sorry I can't provide more information.

 

[elopezmanager]

I called the reimbursement support and spoke to Kelly @ Iovera. She insisted that the codes were correct, that this product is for cryoneurolysis not cryoablation and that is why 0440T is not the correct code. I am not comfortable using 64640 nor 64624. I use encoder pro and the description of these two CPT codes mention electrical current or the use of chemicals to destroy the nerve. Will anyone provide any information or knowledge about this product and its proper code---thank you to everyone in advance

 

[nnelson2]

We bill for an Orthopaedic practice that uses Iovera and we have been receiving reimbursement from Medicare, Aetna, UHC/Oxford and Anthem. We use CPT 64640 and 76942 (our docs use ultrasound guidance). With Anthem it will usually deny and then we submit medical records and we've been paid. We use a diagnosis of knee pain and have had no issues. Cigna does not pay. We've received record requests from UHC as well and have been paid after review with no issues.

 

[cpc2007]

Sharing one additional resource for the coding of cryoneurolysis. The AMA addressed this topic in CPT Assistant April 2019. They had advised a number of years ago to code 64999 for cryoneurolysis, but then updated the guidance and instructed to report 64640. The April 2019 article was an attempt to clarify which set of guidance should be followed. The AMA confirmed that 64640 is the correct code for cryoneurolysis targeting a specific nerve. Because Iovera targets the peripheral nerves around the knee to control knee pain, I think you can support code 64640 based on that clarified guidance from an authoritative source. Payer guidelines of course are a different issue. I think nnelson2's summary of payer payments should help as well.

Kim
www.codingmastery.com