NON-THERMAL ABLATIONS AND THE PAYERS

Review the Policy – This is the safest way in ensuring proper payment. If the non-thermal product you wish to use is NOT on the list of approved procedures, either via the code listing or in the description (or both preferably), then the chances of you being paid have been significantly reduced.

Obtain an Authorization – There are numerous instances where the practice was told that an authorization is not required for a non-thermal technology. The reason no authorization was required is because they are NOT going to pay for it. The representative you are calling only has access to a limited set of data. The data set they are reading does not mention that a code is not going to be covered, only that it is not on the list of codes requiring an authorization.

Obtain a Pre-Determination – If the payer is willing, obtain a pre-determination before treating. This process does take a bit longer and will require medical documentation. A pre-determination will look at both medical necessity and coverage/policy issues.

Try a Small Sample – Before performing a large number of procedures, I recommend performing a case or two, billing those out, see how/if they pay before moving forward with more cases.

All of the non-thermal technologies have positive coverage with Medicare. The exception to this currently is First Coast Service Options (Florida/Puerto Rico). Commercial coverage for the three non-thermals is not as well defined. Again, review the policy of your key payers. Medicare Advantage plans are supposed to follow Medicare guidelines for approval. Many do not. I would not assume that just because Medicare covers it that XYZ Medicare Advantage will as well.

American Physician does not advocate for or against any ablation technology. We only want to ensure physicians receive appropriate reimbursement.