Insurance Reimbursement

GUIDELINES TO CPT CODES – LGMedSupply TENS and Muscle Stimulator Units.

The following documentation is recommended for reimbursement:

A Diagnosis that describes the patients condition Description of treatments that have been attempted and(i.e.medications, physical therapy)

Follow-up visit notes documenting patient benefit from the device (decreased medications, decreased pain, helped with muscle spasms, etc.

CPT Codes:

64550 Application of surface (transcutaneous) (Neurostimulator)

G0283 Electrical Stimulation (unattended) to one or more areas for indications other than wound care, as part of a therapy plan of care

**97014 Application of modality; electrical stimulation (unattended) – Not valid for Medicare use – see G028397032 Application of a modality one or more areas; Constant attendance electrical stimulation (each 15 minutes)

** Not billable through Medicare (refer to G0283)CCI EDITS for TENS

9703264550 Application of surface (transcutaneous) (Neurostimulator)97002 – PT reevaluation1

Ingenix (2004), HCPCS Level II, 2005 Expert. Salt Lake City, St. Anthony Publishing/Medicode.

The National Medicare allowable is determined by multiplying the physician fee schedule conversionfactor [for year 2005, $37.89750 by the total non-facility RVU. 69 Fed Reg (November 15, 2004)]

TENS has FDA clearance for the treatment of post surgical and post traumatic acute pain and chronic intractable pain. Most insuranceplans do cover TENS including Medicare (www.cms.hhs.gov/manuals/103_cov_determ/ncd103index.asp).

To improve the likelihood that the TENS device ewill be reimbursed, it is recommended that the patients medical record include documentation of the condition(s) that justifies medical necessity for a TENS device. Many payors request that a Letter of Medical Necessity be completed by the treating physician.

The Correct Coding Initiative (CCI) was developed by the Centers for Medicare & Medicaid Services(CMS) to prevent payments from being made due to inappropriate HCPCS.

Procedure Coding System–

GUIDELINES TO CPT CODESFOR EMPI PRODUCTS We have compiled this coding information for your convenience.

Every reasonable effort has been made to provide all commonly billed codes that may be applicable to procedures involving the cleared uses of LGMedSupply’s products.

It is ultimately the providers responsibility to determine coverage, and submit appropriate codes, modifiers and charges for the services rendered. The clinician must use independent clinical judgment in choosing codes that most accurately describe the products and/or services provided.

LGMedSupply makes no representation, guarantee or warranty, expressed or implied, that this compilation is error-free or that the use of this information will prevent differences of opinion or disputes with Medicare or other third-party payers, and will bear no responsibility or liability for the results or consequences of its use.

The clinician should also be aware that codes can change over time and/or interpretations of whether a code is properly used in a particular situation is often subject to medical policy interpretation and judgment. There is no guarantee that a local carrier/payer will cover the codesor pay the reimbursement amounts stated in this document.

Local carriers/payers frequently change their reimbursement policies and interpretations. Providers should contact the local carriers/payers for their current interpretation of coverage and coding policies. The key in all coding and billing to the federal government is to be truthful and not misleading and make full disclosures to the government in all attempts to seek reimbursement for a product and/or service.

Documentation recommendations are only guidelines to help our customers to properly document for coverage of medically necessary treatments when using our products. The clinician must use their own judgment when documenting treatment plans assessments.