Coverage and Reimbursement
Coding, Coverage, and Reimbursement Resources
As a service to our customers, we provide resources to assist with coding, coverage and reimbursement for our therapies.
You will find some of these tools available for download on this site, or your may contact us for more information at (866) 877-4102 (option 1).
Remote Follow-up
The Centers for Medicare and Medicaid Services (CMS) released new CPT® codes in 2010. CPT codes and associated billing information for cardiac device monitoring are available for most Medtronic devices. The codes are for in-person and remote encounters, via the CareLink Network.
A guide (PDF, 155 KB) detailing device monitoring codes is also available for use.
Reimbursement for Implantable Cardiovascular Monitors (OptiVol Fluid Status Monitoring)
The CPT codes established for cardiac device monitoring in January 2009 include codes that apply to the review of physiologic data from the OptiVol® Heart Failure Management Report.1
- The new CPT codes related to OptiVol are for device interrogations of physiologic (rather than rhythm) data and not for programming. An interrogation includes physician analysis, review, and report.
- Implantable cardiac monitor (ICM) interrogations can be performed remotely using the Medtronic CareLink Network or in clinic.
- CPT codes released in January 2009 apply to all OptiVol-enabled devices.
Reference
- CPT copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. For CPT codes other than for remote monitoring, the Global CPT codes comprise the Professional and Technical Components. If both components of care are rendered, it is not necessary to append a modifier to the code. However, the remote monitoring codes are an example of a global service that requires two different CPT codes to be billed together, as one code represents the Professional Service and another code represents the Technical Service (eg, CPT 93294 and 93296, 93295 and 93296, 93297 and 93299, 93298 and 93299). The Professional Component reflects physician time and intensity in furnishing the service, including activities before and after direct patient contact.* When only the professional component is performed, modifier -26 should be added to the appropriate CPT code to identify the service. The -26 modifier would not be appended if the code represents only the professional services of the CPT code description (eg, CPT 93294, 93295, 93297, 93298). The Technical Component refers to the resources used furnishing the service, such as office rent, wages of personnel, and other office practice expenses. When only the technical component is performed, the modifier -TC† should be added to the appropriate CPT code to identify the service. The -TC modifier would not be appended if the code represents only the technical support and services component of the CPT code description (eg, CPT 93296, 93299).
† Section 410.32(b) of the Code of Federal Regulations (CFR).