Wiki Breast implants

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tgutierrez

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Dewey, AZ
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Have any ASC's had a problem getting reimbursed on breast implants for post mastectomy history of breast cancer patients?

I'm even getting denial from Medicare now.

Aren't they supposed to pay these under the Womens Health law? I've attempted appeals even with this law and still getting denied and included in the procedure. With the low reimbursement, that doesn't even cover the cost of the implant.

A national appeal letter website we subscribe to states a different position in fact that they would cover external prosthesis but not implanted ones.

Any body have any answers?

Thanks.
 
Thank you for that information.

I just reviewed our DMERC carrier manual online and it does not allow for ASC place of service:
Place of Service
Coverage for any DMEPOS items will be considered if the place of service is:
01 - Pharmacy
04 - Homeless Shelter
09 - Prison/Correctional Facility
12 - Home
13 - Assisted Living Facility
14 - Group Home
33 - Custodial Care Facility
54 - Intermediate Care Facility/Mentally Retarded
55 - Residential Substance Abuse Treatment Facility
56 - Psychiatric Residential Treatment Center
65 - End Stage Renal Disease Treatment Facility (valid POS for Parenteral Nutritional Therapy)

I'm just so lost. Any further advise?
 
Medicare do not pay for breast implant. Consult your HCPC book and look for the payment indicator. L8600 is N1 meaning the implant is already packaged with the procedure and no separate payement will be made. They started doing that 2008 when they had a new payment plan for ASC's. Hope this helps.
 
Thank you. You are just validating what I thought but at the national conference I seemed to be bombarded with the response that they should pay for these so I thought I better check again.

Again, thank you all for review and response.
 
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