Reimbursement/Payment/Utilization
Questions pertaining to Reimbursement, Payment, & Utilization
How much does Medicare spend on hyperbaric oxygen therapy (HBO2)?
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Medicare Payment Amount by CPT/Outpatient APC Codes for Hyperbaric Services CY2009-2015 (Millions of $'s) |
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Professional Claims |
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Calendar Year |
2009 |
2010 |
2011 |
2012 |
2013 |
2014 |
2015 |
||
|
99183 |
42 |
48 |
52 |
56 |
58 |
60 |
50 |
||
|
G0277 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
||
|
Total |
42 |
48 |
52 |
56 |
58 |
60 |
52 |
||
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Outpatient Hospital Facility Claims |
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|
Calendar Year |
2009 |
2010 |
2011 |
2012 |
2013 |
2014 |
2015 |
||
|
Outpatient Prospective Payment System |
122 |
142 |
148 |
162 |
172 |
183 |
170 |
||
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HCPC-(G0277,C1300) APC Code-0659 |
122 |
142 |
148 |
162 |
172 |
183 |
170 |
||
|
Non-Outpatient Prospective Payment System |
3 |
4 |
6 |
6 |
8 |
9 |
7 |
||
|
99183 |
2 |
2 |
3 |
3 |
3 |
4 |
3 |
||
|
C1300 |
1 |
2 |
3 |
4 |
4 |
5 |
0 |
||
|
G0277 |
0 |
0 |
0 |
0 |
0 |
0 |
4 |
||
|
Total |
125 |
146 |
154 |
169 |
180 |
192 |
178 |
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Note: |
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Medicare Claims Integrated Data Repository (IDR) received as of 5/31/2016 with claim "thru" dates between Calendar Years 2009 and 2015 |
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Professional Claims were tabulated by HCPC for NCH Claim Types {71,72,81,82}, while Outpatient Claims were tabulated for NCH Claim Type 40. |
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In most cases, for years 2009-2015 the OPPS packages services for CPT code G0277 and C1300 under Ambulatory Procedure Code 0659. |
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A small amount of spending was billable by CAHs and Short Term Hospitals as unbundled services outside of the OPPS labeled as "Non-OPPS". |
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We (Wellspan Health) had previously asked UHMS to clarify the thinking around the ACLS requirement for a site. My understanding is that UHMS does not require us to have a Crash Cart but we must have chest tubes and an ACLS trained physician. Recently, I heard from a Compliance Manager at BMS that the CMS has started to crack down on sites with no Crash Cart. Do you have any similar information or can you offer any additional guidance?
This is partially true. Some physicians who are not ACLS and audited have had to pay back. In the latest version of the HBO2 Novitas LCD, there is still information requiring ACLS (please see attached document L32739).
We recommend reviewing all MAC policy on a semiannual basis at a minimum.
It was great speaking with you on the phone and I appreciate you taking the time to educate us about the “door-to-door” charging ability of hyperbaric treatments. If you could send me any resources you have, or point me in the right direction regarding where to look in our HBO reference, it would be much appreciated! Even a brief summary of what we discussed over the phone via email about the air breaks and ascent and descent being a part of the time we are able to charge for would be helpful to back us u
CMS published Transmittal 3280, Effective January 1, 2015, HCPCS code C1300, Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval has been discontinued. Hospitals providing hyperbaric oxygen (HBO) therapy should report this service using HCPCS code G0277, Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval that is effective January 1, 2015. The following may be included in calculating the total number of 30-minute intervals billable under G0277: (1) time spent by the patient under 100% oxygen; (2) descent; (3) airbreaks; and (4) ascent.
NOTE: A physician order for a 90-minute HBO treatment typically means that the physician desires that the patient be placed under 100% oxygen for 90 minutes. In order to safely achieve 100% oxygen for 90 minutes, additional time may be needed to provide for the descent, airbreaks, and ascent. Therefore, the total number of billable 30-minute intervals would not be based solely on the amount of time noted on the physician order. In calculating how many 30-minute intervals to report, hospitals should take into consideration the time spent under pressure during descent, airbreaks, and ascent. Additional units may be billed for sessions requiring at least 16 minutes of the next 30-minute interval. For example, 2 units of HCPCS code G0277 should be billed for a session in duration of between 46 and 75 minutes, while 3 units should be billed for a session in duration of between 76 and 105 minutes. Furthermore, 4 units of HCPCS code G0277 should be billed for a session in duration of between 106 and 135 minutes. HBO is typically prescribed for an average of 90 minutes, which hospitals should report using appropriate units of HCPCS code G0277 in order to properly bill for full body HBO therapy. In general, we do not expect that a physician order for 90 minutes of HBO therapy would exceed 4 billed units of HCPCS code G0277.
CMS Manual System: Pub 100-04 Medicare Claims Processing: Transmittal 3280
I have not had to treat a patient yet, but what code is used for a patient with Idiopathic sudden sensorineural healing loss? I cannot find anything even close in my LCD. The ENT doctors are asking me if we provide this service and I know there is a protocol, but will we get reimbursed for offering the treatment.
You won’t find it there because CMS and the MACs who follow CMS policy do not cover the indication at this time.
If they’re of Medicare age and a recipient of MCARE benefits, they’ll need to sign an ABN. For indemnity plans and other managed care, we are hearing they are covering the indication more and more.
Here is a resource I Googled for ICD code - https://www.icd10data.com/ICD10CM/Codes/H60-H95/H90-H94/H91-/H91.23.
Would a patient with a history of diabetes, with a chronic foot ulcer qualify for hbot if they are currently not taking any diabetes meds and their latest A1C is 4.5? Could this ulcer be called A DFU, even though he is no longer dependent on insulin, or any other diabetic meds?
Posted: 8/10/2020
Q:
Would a patient with a history of diabetes, with a chronic foot ulcer qualify for hbot if they are currently not taking any diabetes meds and their latest A1C is 4.5? Could this ulcer be called A DFU, even though he is no longer dependent on insulin, or any other diabetic meds?
A:
I would say that it is still considered a DFU if they had documented DM at one point. They just have well controlled diabetes now...
Enoch Huang, MD
We will be opening an outpatient wound care clinic with Hyperbarics in a non-hospital/ freestanding MOB to treat approved conditions with physician supervision. Will there be 99183 reimbursement to the Physician and also a Facility Fee for GO277 to the clinic?
Posted: 9/28/2020
Q:
We will be opening an outpatient wound care clinic with Hyperbarics in a non-hospital/ freestanding MOB to treat approved conditions with physician supervision. Will there be 99183 reimbursement to the Physician and also a Facility Fee for GO277 to the clinic?
A:
Yes and yes. Direct supervision is required
Helen Gelly, MD
We have a patient with history of head/neck radiation. His oral surgeon would like him to have HBO pre and post dental implant. Patient has medicare. Would this be covered to prevent osteoradionecrosis? Typically marx protocal is completed for extraction vs implant.
Posted: 8/11/22
Q:
We have a patient with history of head/neck radiation. His oral surgeon would like him to have HBO pre and post dental implant. Patient has medicare. Would this be covered to prevent osteoradionecrosis? Typically marx protocal is completed for extraction vs implant.
A:
Our QUAR and HBO2 Committee chairs agreed on the following response.
M’CARE does not pay for preventative care. The existing manifestations of the radiation damage must be treated. Marx protocol for prevention of ORN is not a covered indication for M’CARE, if that is the only thing that they document. You must establish symptoms, define how they failed treatment, and then give them the HBO2.