Wiki Qutenza Billing

Create Wiki
L

lcole7465

Expert
Messages
292
Location
Brooklyn, MI
Best answers
0
I have a NP that has provided placing the Qutenza patch on a patient twice at an outside facility. One claim is in appeal and the other claim Medicare denied the claim as "This specialty is excluded from reporting this service." I have looked in the Internet Only Manual on the CMS website. I discussed this with the office manager and she stated that the procedure cannot be done in our office because we don't have "nurses" and according to her, nurses are the providers that should be placing the patch for treatment. This treatment is new and we've only provided this treatment twice, but I don't want to keep billing for it if we're not suppose to.

I'm looking for any information as to what type of providers are able to bill for this procedure.

Thank you in advance for any information provided.
 
lcole7465 said:
I have a NP that has provided placing the Qutenza patch on a patient twice at an outside facility. One claim is in appeal and the other claim Medicare denied the claim as "This specialty is excluded from reporting this service." I have looked in the Internet Only Manual on the CMS website. I discussed this with the office manager and she stated that the procedure cannot be done in our office because we don't have "nurses" and according to her, nurses are the providers that should be placing the patch for treatment. This treatment is new and we've only provided this treatment twice, but I don't want to keep billing for it if we're not suppose to.

I'm looking for any information as to what type of providers are able to bill for this procedure.

Thank you in advance for any information provided.
Click to expand...
Hi there, I'm not aware of any such Medicare restrictions on billing the capsaicin patch. If an RN was performing the service they'd need to be working incident to a provider who can bill the service. But what code are you reporting and how is your NP enrolled?
 
Hi,

Our pain management physicians are billing the application under CPT code 64999.

Best advice: You should check with each individual insurance plan to determine whether coverage is provided. Qutenza, at no cost, can assist by verifying with the patient’s insurance whether the application and/or patch is covered for the given ICD-10 code or indication. Their representatives are very informative, and they may be able to streamline you into their verification process if needed. They also provide excellent medical necessity documentation that demonstrates how effective the patch is in managing pain. (Please note: HIPAA provisions must be considered when providing them access to any patient information.) Additionally, our local CMS has two LCDs linked to CPT code 64999.

I hope this helps some.
 
You must log in or register to reply here.
Top