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Thread: STIMS in 2014

  1. #1

    Default STIMS in 2014

    I'm wondering if anyone else has heard about the new way Medicare is wanting Stims to be billed. Our rep from St. Jude said as of January 1, 2014 medicare will no longer accept the
    L8680 code and all we will be included in the CPT code 63650, however the reimbursement will take a HUGE nose dive from like $8,000-$10,000 to $1,900 to $2,500 when done here in our office. He also told us that, unlike before, if the procedure is done at a surgical center the reimbursement is almost double that of what we are reimbursed when the procedure is done at our office. The surgical center said that they would be billing the procedure code and we wouldn't anymore. I didn't think that made sense and all this change to Stims is overwhelming. Does anyone have any good information or a place where I can get it? Have other reps been telling you about the new way to bill? Any information, insight, advice, etc... would be a huge help and very much appreciated!! Thanks

  2. #2
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    http://www.cms.gov/Medicare/Quality-...tructions.html

    You can access the final rule from the PQRS page. I searched neurostimulator and 63650, I only found 63650 one time but did not see where it described they would changed the non-facility payment to include the cost of the device/lead.

    Maybe follow up with the rep and ask where their reimbursement unit has identified the documentation of the change in the payment methodology.

  3. #3
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    I just received an email from WPS Medicare J5 that the 2014 physician fee schedule was available. So I looked at 63650 in 2013 first which has an allowable per their fee schedule of $419.53. They do not have on the 2013 a difference between services provided in a facility or non-facility for 2013.

    Then I looked at 2014 and I noticed they now have a reimbursement amount for if performed in facility at $302.70. And they have added non-facility payment at $932.13. But still not aware where to locate that non-facility amount would represent the cost of the lead/array. Thanks for posting this question and hope to hear more about the outcome.

  4. #4
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    I found out that the reimbursement amounts I posted have a 20.1 percent decrease in the conversion factor due SGR formula. Which will likely be appealed by Congress and then these amount would change.

    I will try to contact one the Reps from the SCS company that I know and see if they are aware of the bundling of L code into the payment. And follow up then.

  5. #5
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    Below is the information I received.

    On November 27th, the Centers for Medicare & Medicaid Services (CMS) released the 2014 Final Rules for the Physician Fee Schedule; payment rates will become effective January 1st, 2014.
    Coding and Payment Policy Changes for Spinal Cord Stimulation (SCS) Trials in the Physician Office Setting:
    For 2014, CMS has included non-facility practice expense relative value units (site of service differential payment) for CPT1 code 63650 Percutaneous implantation of neurostimulator electrode array, epidural when performed in the office setting. The 2014 Medicare National Average Payment Rate2 for CPT code 63650 is shown below.
    Because of the uncertainty regarding the projected 2014 Sustainable Growth Rate reduction, Medicare’s 2014 national average payment rates in this document are calculated using two different conversion factors (CF): a) the 2013 CF of 34.023 and b) the 2014 CF of 35.6446 used by CMS to adjust for budget neutrality. Rates are subject to change and do not reflect the projected 2014 Sustainable Growth Rate reduction of 20.1% that would occur unless Congress intervenes

    The payment for trial lead(s) are now included in the non-facility practice expense relative value unit. It is expected that L8680 Implantable neurostimulator electrode, each will no longer be paid separately by Medicare. More information on L8680 and this payment policy will be released by Medicare later this year.
    The multiple procedure payment reduction will apply to CPT code 63650. Payments for additional quantities of CPT code 63650 will be reduced by 50% thus a dual lead trial in the office setting will be paid $1,922-$2,014.

    Why did CMS implement this change?
    Medicare carriers flagged L8680 Implantable neurostimulator electrode, each as a potential overpayment concern. Medicare worked with the American Medical Association and physician societies to develop appropriate office based payment rates based on the cost of the trial lead and the office practice expenses when the procedure is performed in the office.
    How should I code a percutaneous lead trial?
    CPT code 63650 should still be used to code for a percutaneous lead trial. The only change expected for 2014 is that L8680 would no longer be billable in the office for Medicare as the non-facility practice expenses (e.g. lead, supplies, and equipment costs) are already included in the procedure payment. For more guidance on coding for SCS procedures, please refer to the Precision SpectraTM Spinal Cord Stimulation System Frequently Asked Questions which may be accessed through http://hcp.controlyourpain.com/suppo...bursement.html
    Does the Multiple Procedure Payment Reduction Rule still apply to the 2nd, 3rd and 4th leads if applicable?
    Yes, the Multiple Procedure Payment Reduction Rule applies to CPT code 63650. Per this rule, up to 4 additional units may be paid at 50% of the Medicare allowable provided medical necessity is substantiated. MUE (Medically unlikely Edit) limits of 2 units also still apply to CTP 63650.
    Will Non-Medicare payers still utilize L8680?
    The changes outlined in the physician final rule apply to procedures performed on Medicare beneficiaries in the office setting. Boston Scientific encourages physicians to contact their non-Medicare payers for guidance on appropriate coding and payment information for SCS trials.
    When will this change take effect?
    This change will take effect January 1, 2014.
    Will there be a comment period for this Final Rule?
    Yes, comments for this interim final rule are accepted until January 27, 2014. Instructions on how to submit comments are listed on www.regulations.gov , follow the instructions for “submitting a comment.”
    Where can I get more information on this policy change?
    The full text to this Final Rule may be accessed throu

  6. #6

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    Thank you so much for your help! you are amazing!

  7. #7

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    How do you find all of this information? I just barely got my CPC certification and want to be as smart as you one day! Where do I begin? lol

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    It is copy and paste of a PDF that was sent after I requested information from the SCS rep in our region from Boston Scientific. It is a 2014 PDF document but they have not posted it on their website yet; as I just looked to see. In regards, to most resources in general, AMA CPT Assistant Online, AMA CPT Changes Online, Optum Encoder, Medassets Revenue Cycle Solutions, Supercoder, Decision Health Anesthesia and Pain Decisions are the coding programs I use. As well, as email list serves from CMS and the CMS site.

  9. #9

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    Can someone tell me where it is posted that 63650 and L8680 are bundled in 2014. I have looked several different places and can not locate anything. Can someone help me with this?

  10. #10
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    Although Medicare has not released any official bulletins or transmittals directing us not to bill the L8680, their Direct Practice Expense file includes the leads in the new Site-of-Service (SOS) pricing. The following information is from that file:

    63650 RUC Kit, Pack, Tray kit, scissors and clamp kit 0.62 1
    63650 RUC Kit, Pack, Tray pack, basic injection pack 11.67 1
    63650 RUC Kit, Pack, Tray pack, minimum multi-specialty visit pack 1.143 2 1
    63650 RUC Kit, Pack, Tray pack, post-op incision care (suture) pack 4.907 1 1
    63650 RUC Gown, Drape drape, sterile, c-arm, fluoro item 4.504 1
    63650 RUC Gown, Drape drape, sterile, fenestrated
    16in x 29in item 0.557 1
    63650 RUC Accessory, Procedure canister, suction item 3.908 1
    63650 RUC Accessory, Procedure electrode, ECG (single) item 0.09 3
    63650 RUC Accessory, Procedure tubing, suction, non-latex (6ft)
    with Yankauer tip (1) item 2.961 1
    63650 RUC Accessory, Procedure Trial lead kit item 50 1
    63650 RUC Accessory, Procedure Trial lead array item 500 1

    63650 RUC Cutters, Closures,
    Cautery suture, silk, 2-0 to 5-0, x, fs, c item 2.936 1
    63650 RUC Wound Care,
    Dressings bandage, Kling, non-sterile 2in item 0.363 2 2
    63650 RUC Pharmacy, Rx chlorhexidine 4.0% (Hibiclens) oz. 1[/SIZE][/SIZE]

    They break it down to all supplies needed to perform this procedure (drapes, needles, etc.) and the leads are now included. The bold amounts are the price Medicare applied to each of the supplies. How Medicare figured the leads only cost a practice $500 is beyond me, we weren't getting that great of a deal!

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