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Wiki Inspire for Obstructive Sleep Apnea

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mkacmar

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North Chesterfield, VA
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Is anyone having success getting reimbursed for this procedure (0466T and 64568) ? CMS is denying as experimental/ not medically necessary but I'm told other MAC's are paying. I'm submitting with ICD10 G47.33 and Z99.89. Thanks!!
 
Inspire

We are just starting to do this procedure. Would like to know if you are getting paid. The RVU's are minimal in relation to the amount of time spent in the OR. I have 64568 and 0466T and 95970 as the procedure codes to bill. Anyone with experience billing these would be much appreciated.

Thanks!
Marianne
 
Inspire

This is what was communicated to me..CMS is denying these services for OSA because they (CMS) have not removed their internal edits that theses services should be paid for OSA patients. Currently the denials are based on the confusion between Hypoglossal Nerve Stimulation for OSA and Vagus Nerve Stimulation (VNS)for epilepsy or depression. The codes are the same for OSA and VNS. My suggestion is to contact the Inspire reps who can assist you with the appeal process. I've done this for several of our accounts but am still waiting for CMS and others to reimburse for these services for OSA.
 
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