Wiki Sterile Epidural Kits

[saracpm]

I have a steady stream of sales representative come through the office weekly and the latest tread are people trying to persuade my physicians to use "sterile epidural kits". These kits cost about $250 per kit and the reps tell us that they are reimbursed at $600-700 per kit. The code we are being told to use is J3490 which is basically an unlisted code. I am thinking this is not a profitable venture, but I need to convince the doctors of that. Has anyone had any experience with these kits or maybe some documentation about these kits? My other concern is that these kits are not Medicare approved yet, so I am not sure commercial insurances are going to recognize them either.

 

[dwaldman]

Regardless of the setting ASC, Hospital, or Office, for Medicare the payment is for the supplies necessary to perform an epidural is included in the payment under the CPT code.

In a hospital setting an epidural falls under APC 207, which as a national average of 672.04. In ASC, CPT 62311 is around 368.37.

In an office setting, the payment for CPT 62311 is around 224.90.

Their payment methodology is based on including the cost that it would take to perform the procedure which includes things such as fluoroscopy and epidural tray.

It would not be accurate based on the way they pay for procedures that they would reimburse for the epidural tray separately.