Wiki Donated neurostimulator implant (medicare)

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aleach

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Hi Everyone,

Need a little help here.

If our ASC bill's for a neurostimulator implant, but the implant itself is donated, which modifier should we use on a Medicare patient?

Any feedback is appreciated.

Thanks,
A Leach, CPC
 
Medicare does not reimburse for Neurostimulators. You can check addendum BB, they have an N1 Payment indicator.
 
but the reimbursement for the stimulator itself is packaged into the procedure code for the implantation of the device, so a modifier will be necessary..but I've never had this issue so I'm not sure of the modifier. I'm sure someone else will respond (calling Rebecca....lol)
 
I would like to know what modifier to use. We have only had this procedure once since I have been here and I checked on this. No modifier was used and we was still reimbursed (for codes 63685 and 63650). They did reimburse at a higher rate for these procedures. If there is a required modifier, please let me know!! Thanks
 
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rebeccawoodward said:
I can't say I've had this happen before.

Look at the FB modifier: Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples)


http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5263.pdf

Additional link.......

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4250.pdf
Could this work?
Click to expand...


BINGO...I knew you would come through!! Your awesome!! thanks
 
Would that decrease the reimbursement for Medicare with the implant being donated? Ours was not donated the facility purchased it.
 
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as long as the facility purchased it, the reimbursement from Medicare is already calculated in (as per all N1 payment indicators) so you would not use the modifier. However, if you have a case that the rep is giving it to your facility (which they do alot but since you are not back in the OR, you have no way of really knowing), then you would need to use the modifier to let the carrier know "hey we didnt pay for this" so that they can make the appropriate adjustment to the reimbursement.

hope this helps :)
 
Your reimbursement will be reduced if you did not supply the implants. The CMS payment indicator for these is H8 which is device intensive. That means that more than 50% of the cost of the procedure is due to the devices/implants. This is the reason for billing with modifier FB. The contractor will reduce the ASC payment for the procedure by the amount of payment that CMS attributed to the device when the ASC payment rate was calculated.
Thanks.
 
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