Wiki Orthopaedic Implants & UHC

[dyoungberg]

Can anyone tell me if UHC pays ASC for implants placed during orthopaedic surgery? I can't find anything that clearly states they don't, but I have been denied the billing of anchors placed during a rotator cuff repair. They are stating charges are included in the grouper rate for the day.

Thanks

Debbie
NW FL Surgery Center

 

[Tracy K]

They do not pay for them unless you had it carved out in your contract. I also know that you cannot carve them out in any new negotiations. This is also the case for many payors as they are all starting to transition to the CMS payment model.