Wiki Should you code for the SpaceOAR supply???

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slf503

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My office is going to start implanting the SPACEOAR in the office (55874). The business office wants to bill separately for the hydrogel supply. I think it is included in 55874, but do not have any solid documentation from CMS that says that it is. Only a paragraph in 2018 Urology times.
Things may have changed since then - if we should be billing for it, what would the HCPC code be? If not, can anyone guide me to any documentation stating it is included?
 
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I know nothing about SPACEOAR and I am answering the question in general about procedures performed in the office vs facility. The additional costs are built into the practice RVU portion of the total RVUs. That is known as the site of service differential, and it's purpose it to reimburse for the additional supplies, equipment and practice labor. The supplies would not be separately billed.
For the CPT indicated, 55874, total RVU in a facility is 4.77. In your office, it's 93.45. Those additional 88.68 RVUs are the largest site of service differential I have ever seen. I can only assume the equipment or supplies for this are rather expensive.
According to the manufacturer, in a practice, 55874 would be the only code. Hospital outpatient would also bill C1889 but more for tracking purposes, as it will not affect payment. https://www.bostonscientific.com/co...aceOAR_Procedure_Coding_and_Payment_Guide.pdf
I hope that helps explain the theory, and perhaps someone with SPACEOAR specific knowledge could chime in.
 
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csperoni said:
I know nothing about SPACEOAR and I am answering the question in general about procedures performed in the office vs facility. The additional costs are built into the practice RVU portion of the total RVUs. That is known as the site of service differential, and it's purpose it to reimburse for the additional supplies, equipment and practice labor. The supplies would not be separately billed.
For the CPT indicated, 55874, total RVU in a facility is 4.77. In your office, it's 93.45. Those additional 88.68 RVUs are the largest site of service differential I have ever seen. I can only assume the equipment or supplies for this are rather expensive.
According to the manufacturer, in a practice, 55874 would be the only code. Hospital outpatient would also bill C1889 but more for tracking purposes, as it will not affect payment. https://www.bostonscientific.com/co...aceOAR_Procedure_Coding_and_Payment_Guide.pdf
I hope that helps explain the theory, and perhaps someone with SPACEOAR specific knowledge could chime in.
Click to expand...
Thank you for your response!! This is what I have been trying to tell the business office, but wasn't as clear as you. You summed it up nicely, going to steal your words!! Thanks again!
 
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And if you want the RVU difference broken down into dollars and cents? In office, we charge over $7700 for SpaceOAR. In ASC or OR, we charge $345, because the facility is supplying the material. The HCPCS code for the material is built into the CPT, according to my SpaceOAR rep.
 
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The cost of the hyrogel is expressed in the substanially increased practice expense RVUs for the non facility payments. This increased RVUs are for the payment for the kit which also includes the hyrogel material. You do not need to bill for the material vla a separate code or derrug cost.
 
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sls said:
Thank you for your response!! This is what I have been trying to tell the business office, but wasn't as clear as you. You summed it up nicely, going to steal your words!! Thanks again!
Click to expand...
Hi, We are performing the SpaceOAR procedure 55874 with our fiducial placements in the office setting. Do we need to add a 59 modifier to the 55876 Fiducial Marker Placement? Please advise. Thanks, Dawn
 
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