Posted on Feb 27, 2015 11:17:00 AM by Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD

PTNS Is Reimbursed For All Medicare Beneficiaries

3rd Line Treatment of OAB Is Covered 

If you haven’t heard the best Urgent PC news ever, as of August 10, 2014, PTNS is a PTNS Is Reimbursed For All Medicare Beneciariesreimbursed therapy for ALL Medicare beneficiaries in the United States. National Government Services (NGS) has issued a positive coverage decision for PTNS for the treatment of urinary urgency, urinary frequency and urge incontinence associated with overactive bladder. 

This is really exciting. NGS covers approximately 10 million elders in the states of New York, Illinois, Massachusetts, Wisconsin, Minnesota, Connecticut, Maine, New Hampshire, Rhode Island and Vermont. For some, this policy recaptures, and improves upon, the coverage they previously had with other Medicare contractors.

For others, like those in New York and Connecticut, this marks the first time they have Medicare coverage. They can finally treat Medicare patients who have refractory OAB with the only non-drug, non-surgical 3rd line therapy recommended by the AUA and SUFU for the treatment of OAB!

Reimbursement Logistics

Taking an organized approach to getting your patients ready and making sure you get paid will take some planning. Do you have a dedicated biller who can pre-authorize your patients who are not Medicare beneficiaries? Medicare recipients do not need pre-authorization in general. However, be careful that you are identifying their carrier and make sure their carrier covers them away from their state. This has been a problem for patients in Michigan who have a local carrier for their Medicare insurance and who go south for the winter. Coverage varies between Medicare carriers.

It is also important to have your biller check to see if your patients have a secondary insurance that will cover the Medicare 20% co-pays. For straight Medicare, patients pay 20% of the Medicare-approved amount for the doctor or other health care provider's services. For Medicare Advantage Plans, the co-pay amount will depend on a patient’s specific plan. The co-pay amount is usually listed on the patient’s insurance card.

Remember to use the proper codes. The ICD-10 CM diagnostic codes that are covered are:

N32.81 overactive bladder (hypertonicity of bladder)

N39.41 urge incontinence

R35.0 urinary frequency

R39.15 urgency of urination

The CPT® code you will be using for PTNS is 64566, posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming.

If you are ever in need of additional support, do not hesitate to go to visit www.urgentpcreimbursement.com. This site offers you up-to-date coverage and coding information. Don’t forget to give your field representative a call either. If you have not yet met him or her, call Cogentix Medical customer service at (866) 258-2182 and they will promptly be in touch. 

Urgent PC for OAB Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at www.cogentixmedical.com. Urgent PC is a registered trademark of Cogentix Medical © 2015 Cogentix Medical. All rights reserved. 
Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD
Leslie Saltzstein Wooldridge, GNP-BC, CUNP, BCIA-PMD, is Director of the Adult Bladder Control Center, Mercy Health Partners, Muskegon, Michigan USA. Ms. Wooldridge received a Master of Science degree in nursing administration, critical care nursing and postgraduate certification as a Geriatric Nurse Practitioner from Marquette University, Milwaukee, Wisconsin. In 2015, she was honored with the Women’s Health Foundation Activist Award. She is also the recipient of the 2009 National Association for Continence Rodney J. Appell Continence Champion Award. Ms. Wooldridge has published in multiple refereed journals. She authored the Genitourinary chapter in The Nurse Practitioner in Long Term Care: Guidelines for Clinical Practice (2007). She has lectured throughout the United States on geriatrics, urology and clinical practice.
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