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ON-Q Pain Pump reimbursement experiences?

  1. Red face ON-Q Pain Pump reimbursement experiences?
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    Hello everyone!
    Just met iflow reps for the On-Q pain pump. They are pushing to add this pain mgmt device to our surgeries, LAVH, etc. Device code is A4306, charging for the "placement of the catheters has to be an unlisted CPT 49999, with addition of 59 mod" to get paid for it. Being unlisted it will have to go paper with major documentation, etc. I'm fine with that but:

    I went to my local NY Medicare carrier (NGS)- and regardless of Iflow propaganda- [B]My NY Medicare says its NOT reimbursable as a separate charge, and will be denied inclusive to the global surgery. I also see that my commercial carriers treat it the same way for all their MAP's. Now I wonder if its even worth bringing this on board!

    Has ANYONE out there gotten paid for the use of the On-Q pain pump from MCR or Any Commercial payors? especially NY billers? THANK YOU !!!!

  2. #2
    nOPE, NEVER paid . none at all

  3. Default
    thanks! I always have to prove it to my docs to keep them from jumping too quick- appreciate the honest response!

  4. #4
    Evansville Indiana
    Default Pain pump
    Several years ago, I had a client who was a surgeon and he went out and bought these based on promises of dollars to make. Of course he failed to come to us first to see if they were even a covered service. Needless to say, he was not very happy when he found out that it would come out of his pocket.

  5. #5
    I work OB GYN, and 3 of my 5 practices use the On Q. Most carriers don't pay this, although we do win some appeals. Medicare came out with specific policy stating the ON Q is included in the global surgical service, so forget about Medicare. A few commercial carriers have followed suit. I expect more will soon. If there's no written policy, then we bill it, appeal it once, and write it off if we don't win the appeal. My docs like the patient benefits enough that they continue to use the pump regardless of extra $$. I don't believe they pay for the supply, though--I think the hospital carries the expense.

    Becky, CPC

  6. #6
    I think most reps dont know codes , they know what to sell, and say whatever they have to becausec they are salsman , thats their job. They heard it from one person and they go with it. Sorry reps, not putting yall down , just speaking from past experiences , we just had a rep this past year told my supervisor abour certain codes we can use for ballon sinus surgery, tHAT WAS A JOKE !, when I question him, HE DID not have a straight answer, could not give me a number where he got the info from, so NO i do not most trust reps, sorry that just my thought.

  7. #7
    Des Moines, IA
    I'm posting a link to the Noridian Medicare website which says it's not reimbursable and considered inclusive.

  8. Default Pain Pump
    We always have to appeal for the On-Q. My doctor's are in New York and we accept everything except Medicaid. I would say the reimbursement is approximately 60%.

    The doctor's I work for explain to the patient that the cost to them will be $200 if their insurance company does not pay for the On-Q. We do everything in our power to appeal and contact insurance companies, but the bottom line is that the patient is responsible if it is not covered.

    Is this correct, I always feel bad for the patient if it is not covered. But the patient is made aware prior to their procedure, and my doctor's make them pay up front, and receive a refund if it is covered.

    My question to everyone is, do your doctor's make the patients pay up-front for supplies, and then reimburse them if it is covered?

  9. Default
    We have never been reimbursed for the pain pump. I do have a question, is the pump being administered by your physician but supplied by the hospital? Something to think about.

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