Responses: WalkAide Reimbursement
Scott Freeman
Description
Collection
Title:
Responses: WalkAide Reimbursement
Creator:
Scott Freeman
Date:
3/26/2009
Text:
Thank you to all that responded.
Regards,
Scott Freeman
Original Post:
Since the WalkAide received a CMS reimbursement code which was
supposedly effective January 1, 2009, has anyone submitted for
reimbursement of the device or are patients still paying out of pocket
for it? If you have submitted for reimbursement what is the
reimbursement level for the WalkAide? I have contacted CMS on several
occasions with no avail. Thank you so much for your help.
Scott Freeman
Responses:
There are certain guidelines that have to be followed. The walk Aide
people should fill you in on what you need to do. They want to do all
the billing for you. The code issued by Medicare is a broad based code.
remember medicare will only approve walkaide for spinal cord injuries
and documentation is very strict. I haven't tried billing but diagnosis
is key
My understanding is the E-code is valid only for peripheral nerve injury
cases and not for upper motor neuron pathologies as it is intended to be
used for. Please validate this with IN, however when I spoke with them
early this year that was their interpretation of the HCPC coding
literature.
Therefore the ICD-9 code has a range restriction to pathologies which
are not meant to be treated with this device. Apparently it has
something to do with lumping this device in with a competing technology
that is indicated for peripheral lesion conditions.
You need to contact Innovative Neurotronics. They are submitting to the
insurance companies on our behalf. They have a whole packet of info
that needs to be filled out on each patient. We have not yet had an
insurance company pay for it, but I have about 4 pending with
Innovative. Currently we are having the patients still pay, and if we
get reimbursed we will reimburse the patients.
e code is e0770 and medicare will reimburse only for spinal cord
injuries. there are other requirements as well such as pt must have 32
pt appts, a lot of documentations and so for. innovative neurotronics
now has a department which will predetermine patients benefits for ur
patient. it takes approx 10 to 30 to get the predetermination. inn inc
lists the walkaide fot over 8grand so that well get approx 4500 to 5000
after insurance discounts. if a patient is paying out of pocket the
list price should be 4520. electrodes are extra.
I don't do walkaid business but is this one of those scenarios where
Medicare gave us a code without a $ amount. They have the O&P community
submit reasoning for their price over a trial period like all of 2009
before they establish a price for the code? Remembering back when we
received the L code for the rocker sole there was no reimbursement
amount attached. We had to send in an amount and reasoning why we would
bill that $. Since I do mostly prosthetics I am not even sure if we
have an amount for the rocker code.
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Regards,
Scott Freeman
Original Post:
Since the WalkAide received a CMS reimbursement code which was
supposedly effective January 1, 2009, has anyone submitted for
reimbursement of the device or are patients still paying out of pocket
for it? If you have submitted for reimbursement what is the
reimbursement level for the WalkAide? I have contacted CMS on several
occasions with no avail. Thank you so much for your help.
Scott Freeman
Responses:
There are certain guidelines that have to be followed. The walk Aide
people should fill you in on what you need to do. They want to do all
the billing for you. The code issued by Medicare is a broad based code.
remember medicare will only approve walkaide for spinal cord injuries
and documentation is very strict. I haven't tried billing but diagnosis
is key
My understanding is the E-code is valid only for peripheral nerve injury
cases and not for upper motor neuron pathologies as it is intended to be
used for. Please validate this with IN, however when I spoke with them
early this year that was their interpretation of the HCPC coding
literature.
Therefore the ICD-9 code has a range restriction to pathologies which
are not meant to be treated with this device. Apparently it has
something to do with lumping this device in with a competing technology
that is indicated for peripheral lesion conditions.
You need to contact Innovative Neurotronics. They are submitting to the
insurance companies on our behalf. They have a whole packet of info
that needs to be filled out on each patient. We have not yet had an
insurance company pay for it, but I have about 4 pending with
Innovative. Currently we are having the patients still pay, and if we
get reimbursed we will reimburse the patients.
e code is e0770 and medicare will reimburse only for spinal cord
injuries. there are other requirements as well such as pt must have 32
pt appts, a lot of documentations and so for. innovative neurotronics
now has a department which will predetermine patients benefits for ur
patient. it takes approx 10 to 30 to get the predetermination. inn inc
lists the walkaide fot over 8grand so that well get approx 4500 to 5000
after insurance discounts. if a patient is paying out of pocket the
list price should be 4520. electrodes are extra.
I don't do walkaid business but is this one of those scenarios where
Medicare gave us a code without a $ amount. They have the O&P community
submit reasoning for their price over a trial period like all of 2009
before they establish a price for the code? Remembering back when we
received the L code for the rocker sole there was no reimbursement
amount attached. We had to send in an amount and reasoning why we would
bill that $. Since I do mostly prosthetics I am not even sure if we
have an amount for the rocker code.
<mailto:<Email Address Redacted>>
This electronic message is intended for the exclusive use of the above named recipient. Use by persons other than the intended recipient is prohibited. If you are not the above named recipient and you have received this electronic message in error, you should not review the content of this message or otherwise use, disseminate, distribute or copy this message. Please immediately notify the sender of the error via a reply to this message and then permanently delete this message from your system.
ELECTRONIC MESSAGES CANNOT BE GUARANTEED TO BE SECURE, CONFIDENTIAL, DELIVERED AND/OR RECEIVED IN A TIMELY MANNER OR WITHOUT ERROR. Avondale Partners does not accept or assume any liability for any error or omission in the transmission and/or receipt of electronic messages. Avondale Partners employs software to monitor, review and archive incoming and outgoing electronic messages. Nothing in this electronic message should be considered a solicitation of or an offer to buy or sell securities. All opinions, prices, and/or estimates are subject to change without notice.
Citation
Scott Freeman, “Responses: WalkAide Reimbursement,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/230274.
