Download United States Reimbursement for Image-Guided Acoustic

United States Reimbursement for
Image-Guided Acoustic Surgery for Uterine Fibroids
The ExAblate® System uses highly-focused acoustic beams of non-ionizing radiation to thermally ablate the uterine
leiomyomata tissue involved. The procedure is integrated with real time magnetic resonance (MR) imaging that is used to
image the patient anatomy, identify the contours of the leiomyomata, guide the treatment location, and continuously
monitor outcomes, thus allowing the user to adjust treatment parameters during the procedure to achieve the desired
results. Image-guided acoustic surgery using the ExAblate System may also be referred to as MR-guided focused
ultrasound surgery (MRgFUS).
Image-guided acoustic surgery using the ExAblate System is usually completed in a single session and involves the
following:
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Positioning the patient on a robotic coach with stereotactic immobilization devices;
Administering anesthesia;
Verifying patient position and sonication pathway using MR imaging;
Generating a patient-specific (personalized) treatment plan based on treatment volume, surrounding anatomy, and
defined fibroid margin;
Using the 5 degree of freedom transducer to move and position the acoustic phased array to achieve accurate
targeting;
Transmitting multiple acoustic beams from the 3D acoustic phased array of transducer elements to generate high
enough intensity at the focus to produce a thermal dose and destroy the targeted tissue;
Monitoring the patient continuously using MR imaging to maintain accurate targeting;
Performing a contrast-enhanced MR scan immediately after treatment to evaluate treatment effect;
The costs of medical devices generally are included in the costs for the procedure in which the device is used and
are billed using the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System
(HCPCS) code for the procedure.
The ‘T’ codes are temporary HCPCS Level III procedure codes which have been assigned Ambulatory Payment
Classification (APC) group 0067 for payment before the wage base is applied.
CPT/HCPCS
Code
0071T
0072T
Description
CPT 0071T—Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total
leiomyomata volume less than 200cc of tissue.
CPT 0072T—Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total
leiomyomata volume greater than or equal to 200cc of tissue.
Professional Reimbursement for Image-Guided Acoustic Surgery
CMS does not establish payment rates for professional services billed using unlisted codes or the C9374 code. Medicare
contractors usually consider information from professionals, then crosswalk such services to an existing CPT code that has
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Inquiries: [email protected]
1
Disclaimer: The coding, coverage, and payment information contained herein is gathered from various resources and is subject
to change without notice. InSightec cannot guarantee success in obtaining third-party insurance payments. Third party
payment for medical products and services is affected by numerous factors. It is always the provider’s responsibility to
determine and submit appropriate codes, charges, and modifiers for services that are rendered. Providers should contact thirdparty payers for specific information on their coding, coverage, and payment policies, or utilize other resources such as their
Compliance Department to ensure proper claim submission.
an assigned value. Other payers, including private payers and payers from other government programs, may also establish
professional payment rates for procedures billed using an unlisted code based on a crosswalk. The crosswalk allows payers
to equate an unvalued CPT code to an established CPT code, incorporating utilization of resources, including physician time
for professional services.
An appropriate crosswalk for image-guided acoustic surgery using the ExAblate System for professionals may include the
following:
CPT Code
77435
Description
Stereotactic body radiation therapy, treatment, management, per treatment course, to 1 or more
lesions, including image guidance, entire course not to exceed 5 fractions
Separately Payable Services for Image-Guided Acoustic Surgery
In conjunction with image-guided acoustic surgery using the ExAblate System, it may be appropriate for hospital
outpatient departments and/or physicians to bill for other separately payable services. Such separately payable services
may or may not include the following:
CPT Code
Description
77295
Therapeutic radiology simulation-aided field setting; 3-dimensional
77334
Treatment devices, design and construction; complex (irregular blocks, special shields,
compensators, wedges, molds or casts)
77370
Special medical radiation physics consultation
77470
Special treatment procedure (e.g., total body irradiation, hemibody radiation, per oral or
endocavitary irradiation)
According to the AMA, “the listing of a service or procedure and its code number in a specific section of this book does
not restrict its use to a specialty group. Any procedure or service in any section of this book may be used to designate the
services rendered by any qualified physician or other qualified health care professional or entity ….” CPT Professional
Edition, 2013, at x.
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___________________________________________________________________
Inquiries: [email protected]
2
Disclaimer: The coding, coverage, and payment information contained herein is gathered from various resources and is subject
to change without notice. InSightec cannot guarantee success in obtaining third-party insurance payments. Third party
payment for medical products and services is affected by numerous factors. It is always the provider’s responsibility to
determine and submit appropriate codes, charges, and modifiers for services that are rendered. Providers should contact thirdparty payers for specific information on their coding, coverage, and payment policies, or utilize other resources such as their
Compliance Department to ensure proper claim submission.