Year End Update on New Technologies

During the past year we have commented on some of the newer technologies. As I still receive a number of questions about them, I thought an end of year re-cap might be in order as we all begin to contemplate how to have a successful 2016.

Varithena: We have had good success billing for Varithena to the various commercial payers. The reimbursement rate for the procedure using 37799 has paid at a reasonable level, typically between a laser and an RF ablation rate for that area. The drug, using code J3490, has likewise mostly been paid at a reasonable rate to cover the costs as well. A few caveats for your consideration:

  1. We do not recommend using Varithena on Medicare primary patients. The J code has not been paid on any of our test claims. BTG notes some anecdotal stories of the J code being paid but this is certainly the exception and not the rule.
  2. Some payers have specific exclusions regarding the use of Varithena in their policies. We strongly recommend reviewing your key payers’ policies prior to using Varithena.
  3. We also recommend billing a few Varithena claims to your key payers and then waiting to see how these process and pay. We have noted some very different reimbursement methodologies being employed dependent upon the practice’s contract with that payer.
  4. Finally, we have seen some claims be down coded from a 37799 to a 36470 sclerotherapy injection. The payer notes that there are existing codes for introduction of a sclerosing solution via a needle (36470 and 36471).

VenaSeal: As of November of this year, this product is now available in the United States. Medtronic notes that it is marketed primarily for cash pay patient use. There is no specific code for this product. If it is billed, the 37799 code would be appropriate for the procedure and the supplies. Unfortunately you cannot separately bill for the cost of the supply. If billed to a commercial payer, the expected reimbursement is expected to be the same as a laser. Due both to the product being new and the marketing of it for treatment of cash pay patients, we have not billed any VenaSeal claims to the various payers.

ClariVein: While ClariVein’s specialty infusion catheter with a rotating tip has been on the market for some time now, there have been enough reimbursement questions and changes for it to be in our ‘newer technologies’ section. We have consistently maintained that the 37799 code is the appropriate code while ClariVein appears to recommend the 37241 code. A few items for your consideration:

  1. The reimbursement rates for the 37241 code are very high. Unfortunately, the code notes that the physician is performing an embolization. When we contacted the AMA, they noted it should be billed using the 37799 code.
  2. The 37799 code is indeed the catch-all code and has extremely varied results in regards to reimbursement.
  3. Some payers have specific exclusions regarding the use of ClariVein, MOCA, or endomechanical ablations. We strongly recommend reviewing your key payers prior to using this device.
  4. We have seen claims with 37241 code that were billed. The initial results were positive. However, these practices are now being denied similar claims noting it is an inappropriate procedure code for this service, or; because the use of this device is considered ‘experimental and investigational’.

We have been told that ClariVein is in pursuit of a specific CPT code much like laser or RF’s 36478 and 36475 respectively. As soon as we hear that that such a code has been created, we will update our readers.

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