Posted on Jan 24, 2017 3:03:54 PM by Cogentix Medical

Reimbursement for Urgent PC Continues to Improve!

Good Reimbursement News!While Posterior Tibial Nerve Stimulation (PTNS) with Urgent PC has been reimbursed by all Medicare Contractors since August of 2014, Cogentix Medical has continued to rally for improved coverage, especially in regards to maintenance treatments. A recent policy update by Novitas Solutions, Inc. to extend coverage for PTNS maintenance therapy through three years further cements providers’ ability to offer Urgent PC to their patients as a long-term option.

Maintenance Therapy for CPT® Code 64566 (PTNS) Covered by all Medicare Contractors

All Medicare contractors cover maintenance therapy. However, the duration of coverage as well as the allowed time between treatments varies as shown below. Coverage criteria, documentation requirements, and ICD10 Codes also differ as detailed in the various policies. Our Urgent PC Reimbursement Guide offers the basics but be sure to check out the policies on www.cms.gov for the full details.

Medicare Contractor

Duration

Treatment Interval Beyond Initial 12

Policy

NGS

Indefinite

Every 1-2 months

L33396

CGS Administrators, LLC

Indefinite

Not specified

Coverage Article

Noridian Healthcare Solutions, LLC

Beyond 3 years

Every 3 weeks

A55104 - Jurisdiction J-E

A52965 - Jurisdiction J-F

Novitas Solutions, Inc.

3 years maximum

Every 1-2 months

L35011

Wisconsin Physicians Service Insurance Corporation

2 years

1 every month

L34436

Palmetto GBA, LLC

2 years

Every 3 weeks 

L33443

First Coast Service Options, Inc.

1 year

Every 1-2 months

L33406

Cahaba GBA, LLC

1 year

Every 1-2 months

L34296

* More information about Medicare contractors and the areas they serve can be found on the CMS website.

Among Private Payers, coverage for maintenance therapy also varies. Check the PTNS Coverage Finder for more information.

The Need for PTNS Booster Treatments

Research shows that up to 80% of patients respond to Urgent PC PTNS therapy with substantial reductions in urinary urgency, urinary frequency and urinary accidents.  Even better, the STEP clinical study demonstrates that successful patients are able to maintain their improvements with an occasional treatment, referred to some as a booster treatment. While patients in the STEP study averaged a treatment every 3.1 weeks, in clinical practice the time between treatments is individualized, with some patients going months between treatments. 

A typical approach to incorporating maintenance treatments is to schedule a follow-up appointment 1 month following the initial series and adjust the frequency of treatment as needed. For example, if symptoms began to reoccur at that appointment, schedule the next treatment 3 weeks out (if allowed by the patient’s insurance provider). But if the patient was able to maintain their results, push the next treatment 5 weeks out. View the blog on maintenance therapy for more information.

Ongoing Commitment to Reimbursement

Cogentix is committed to working with payers to ensure optimal coverage for PTNS with Urgent PC.  If you have any questions about reimbursement or our ongoing efforts, talk to your Territory Manager or contact our Reimbursement Support Group at 866.258.2182 or reimbursement@cogentixmedical.com.

Urgent PC is the Proven PTNS

Cogentix Medical has compiled this coding information for your convenience. This information is gathered from third-party sources and is subject to change without notice. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. It is always the provider’s responsibility to determine medical necessity and submit appropriate codes, modifiers, and charges for services rendered. Please contact your local carrier/payer for interpretation of coding and coverage. Cogentix Medical does not promote the use of its products outside their FDA cleared or approved labeling. 

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 © 2016 Cogentix Medical. All rights reserved. 

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