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Thread: Novasure, Thermachoice, Essure

  1. #1

    Default Novasure, Thermachoice, Essure

    AAPC: Back to School
    Are any of you having any luck getting higher reimbursment for Novasure Thermachoice and Essure being done in an office visit setting vs at the hospital?

  2. #2
    Join Date
    Apr 2007
    Tacoma, WA


    Quote Originally Posted by samantha Martel View Post
    Are any of you having any luck getting higher reimbursment for Novasure Thermachoice and Essure being done in an office visit setting vs at the hospital?
    You should be getting a lot higher reimbursement but be sure you are using the office POS on your claim. The reimbursement is driven by the place of service RVUs, so showing that the procedure was in office with an 11 POS should automatically bump things up! The Novasure code is 58563 and the Essure code is 58565.
    Arlene J. Smith, CPC, CEMC, COBGC
    AAPC Tacoma WA Chapter

    President 2015
    Past-President 2013 and 2011
    President-Elect 2010
    Member Relations 2008
    AAPC NAB 2007-2009

  3. #3


    I will always look at the reimbursement and if it is less than it should be I call the insurance and make sure that they processed the claim as in the office. They make this mistake sometimes.

    Robin King, CPC

  4. #4


    I know this response is a little late from the original post; however I wanted to share some of my knowledge about officevs. hospital reimbursement. Knowing all of your fee schedules is the first factor in reimbursement, but even more important asking the insurance company if there is a site of service differential between office and hospital. I have found that there are a few that wont reimburse you for in the office at a higher rate like Great West. (depending on your contract). Dont forget to bill for the injection medication, and urine sample if provided in the office prior to the procedure.

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