Initial Varithena Payment Results

Not surprisingly, we have a number of clients that have treated some patients using the new Varithena Polidocanol injection program. We also have several more interested in both the clinical feedback and the financial feedback. Based on a number of telephone calls over the past few months, we believe a large number of our readers are likewise interested. As before, our sole interest in any of the technologies is ensuring the financial compensation is suitable for our physicians.

Two claims with a date of service of 8/27/14 were submitted on 8/28/14. The claims were ‘crosswalked’ to code 36475 on the CMS 1500. The payers for these two claims were United and Aetna (Florida, although these are both national corporations). We did receive records requests which were promptly sent. We received notification of payment on 10/22/14.

The results are:
United: Code 37799 allowed/paid – $ 802.00
Code J3490 allowed/paid – $ 426.00

Aetna: Code 37799 allowed/paid – $ 601.50
Code J3490 allowed/paid – $ 319.50

The results are unsatisfactory at this time. We are already working with Varithena’s accounts receivable department regarding an appeal of the low payment amount. To their credit, they were calling us almost as soon as we knew the above information.

Any new technology is going to have a few ‘operational’ issues with the payers. Here’s hoping there is speedy acknowledgment and understanding by the several payers.

As these claims roll through the appeal process to obtain additional reimbursement, and as we receive a larger sample size from our clients throughout the US; we will update you with current information via our blog and email service to our readers.