Anthem BCBS now covers Intracept!

[Taus]

https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_a053351.html
https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_a053351.html (https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_a053351.html)

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[SSdoc33]

IDET?

 

[Taus]

IDET?

No. Only bvna is covered.

 

[RoloTomassi]

Link doesn't work. Did they change their minds?

 

[Taus]

Link doesn't work. Did they change their minds?

Try now, re-copied link

 

[Ducttape]

looks like BVNA is the only one of those procedures that is approved, providing 6 months of back pain without improvement in symptoms.

importantly - needs 6 months of conservative therapy.

in other words, theres a good chance that you probably wont be doing the treatment on someone you make the diagnosis on.

 

[Taus]

looks like BVNA is the only one of those procedures that is approved, providing 6 months of back pain without improvement in symptoms.

importantly - needs 6 months of conservative therapy.

in other words, theres a good chance that you probably wont be doing the treatment on someone you make the diagnosis on.

Not sure I understand that last sentence. You don’t see chronic low back pain, where patients have tried a variety of treatments before seeing you? you don’t have some patients with this diagnosis who just don’t get better with meds, PT, DC, injections, etc.?

 

[Ducttape]

im suggesting that you see the patient, you start PT. you end up getting the MRI scan after 6 weeks. you tell the patient "im going to be able to do an injection that i cannot order for another 4 months 2 weeks."

a lot of those patients will "f#Ck this, im going to see this pain doc who is advertising this procedure who will get me in." it may take a month or 2 to get in, but that doc will be able to ask for auth because of the work you put in to get him ready for the BVNA...


i have issue with the 6 month part, is all.

 

[SpineandWine]

Any role in antibiotic for modic changes?

 

[MitchLevi]

It means that select pts will be able to get BVNA if you've been trying different things for 6 months.

 

[RoloTomassi]

im suggesting that you see the patient, you start PT. you end up getting the MRI scan after 6 weeks. you tell the patient "im going to be able to do an injection that i cannot order for another 4 months 2 weeks."

a lot of those patients will "f#Ck this, im going to see this pain doc who is advertising this procedure who will get me in." it may take a month or 2 to get in, but that doc will be able to ask for auth because of the work you put in to get him ready for the BVNA...


i have issue with the 6 month part, is all.

You don't have to have been doing the care for 6 months. They could've been managing with another pain doc, PCP, PT, etc. They see you and it's been 6 months since their pain started and they've tried a bunch of stuff, they will be good to go.

 

[bedrock]

You don't have to have been doing the care for 6 months. They could've been managing with another pain doc, PCP, PT, etc. They see you and it's been 6 months since their pain started and they've tried a bunch of stuff, they will be good to go.

Exactly.
Not sure why some people are overthinking this.

 

[cowboydoc]

Any role in antibiotic for modic changes?

There was a paper that advocated for this circa 2012.

I haven't prescribed antibiotics for back pain or modic changes in a decade of practice. I don't see that changing any time soon.

 

[Taus]

Hopefully the professional fee will be decent. Once you get efficient, each level can definitely be done in 15 minutes including access plus burn. You should be placing the first electrode in the second cannula as soon as the first is done burning.

30 minutes single level cases should be the norm…… barring the occasional exception for anatomical variables.

 

[lobelsteve]

Any role in antibiotic for modic changes?

One small study in Sweden for 100 days of abx.

 

[Dr. Ice]

Meh I’m happy to refer out to whomever wants to take the burden to do this treatment..

I’ve been trying to get out of doing genicular rfa..it’s a time waster and basically I’m doing it for free, but my ortho partners are telling me I should consider it like charity care that they have to do for trauma cases…😳 so cool, I’m “charatizing” your failed knees…cool story bros

Don’t really need to do another procedure that may pay or kind of pays but wait you have to jump through this or that or 6 months or whatever. They can go somewhere else

 

[callmeanesthesia]

Meh I’m happy to refer out to whomever wants to take the burden to do this treatment..

I’ve been trying to get out of doing genicular rfa..it’s a time waster and basically I’m doing it for free, but my ortho partners are telling me I should consider it like charity care that they have to do for trauma cases…😳 so cool, I’m “charatizing” your failed knees…cool story bros

Don’t really need to do another procedure that may pay or kind of pays but wait you have to jump through this or that or 6 months or whatever. They can go somewhere else

Genicular RFA non-facility price of about $400 for Medicare. That’s not too bad for a 15-20 minute procedure.

 

[PinchandBurn]

Game changer

 

[bedrock]

Genicular RFA non-facility price of about $400 for Medicare. That’s not too bad for a 15-20 minute procedure.

I’d say it’s damn hard to do a good genicular RFA in 15 min, as an in office procedure so using just local +/- Xanax.

Patients are often sensitive without an iv so in office u you have to go slow and numb a lot.

Plus genicular location is variable, so a good genicular RFA means two standard burns or using expensive expandable needles, for a procedure that already doesn’t pay well.

 

[callmeanesthesia]

I’d say it’s damn hard to do a good genicular RFA in 15 min, as an in office procedure so using local +/- Xanax.

Patients are often sensitive without an iv so in office u you have to go slow and numb a lot.

Plus genicular location is variable, so a good genicular RFA means two standard burns or using expensive expandable needles, for a procedure that already doesn’t pay well.

Private practice. Agree it’s not always easy - sometimes they have a hard time. But I won’t do it at the ASC - that’s really charity care.

Standard 18g RFA needles. Xanax, or Xanax and Norco if they had a hard time with the dx block (not a lot of either especially if old). Numb skin with 27g. Stick in a spinal needle down alongside bone and numb the tract. Insert RF needles. Check depth on lateral. Pull back about 2 cm and then back in to final depth while injecting 2% lidocaine. Test, RF 80 deg 90 sec, then pull back 1 cm and repeat.

 

[painfree23]

is this an easy procedure to learn? Never done one.

 

[SpineandWine]

I’d say it’s damn hard to do a good genicular RFA in 15 min, as an in office procedure so using just local +/- Xanax.

Patients are often sensitive without an iv so in office u you have to go slow and numb a lot.

Plus genicular location is variable, so a good genicular RFA means two standard burns or using expensive expandable needles, for a procedure that already doesn’t pay well.

How are you guys even getting these covered? Genic RFAs have are all being denied with Medicare advatage plans (which a large portion of my practice is)

 

[lobelsteve]

I’d say it’s damn hard to do a good genicular RFA in 15 min, as an in office procedure so using just local +/- Xanax.

Patients are often sensitive without an iv so in office u you have to go slow and numb a lot.

Plus genicular location is variable, so a good genicular RFA means two standard burns or using expensive expandable needles, for a procedure that already doesn’t pay well.

I have not encouraged those levels of pain during this procedure.

 

[Ducttape]

You don't have to have been doing the care for 6 months. They could've been managing with another pain doc, PCP, PT, etc. They see you and it's been 6 months since their pain started and they've tried a bunch of stuff, they will be good to go.

im not sure how Anthem is.

my experience with other insurers is that this will be interpreted as 6 months with that provider.

you did pick up on my point - "they could've been managing with another pain doc".

for those with anthem, congrats and good luck.

How are you guys even getting these covered? Genic RFAs have are all being denied with Medicare advatage plans (which a large portion of my practice is)

you dont. dont even bother trying. and you can ask them to self pay but these patients wont.

save it for Medicare only, or private insurers.

 

[lobelsteve]

Anthem will likely cover it, but would not believe it until it shows in AR.

 

[Multimodal]

Private practice. Agree it’s not always easy - sometimes they have a hard time. But I won’t do it at the ASC - that’s really charity care.

Standard 18g RFA needles. Xanax, or Xanax and Norco if they had a hard time with the dx block (not a lot of either especially if old). Numb skin with 27g. Stick in a spinal needle down alongside bone and numb the tract. Insert RF needles. Check depth on lateral. Pull back about 2 cm and then back in to final depth while injecting 2% lidocaine. Test, RF 80 deg 90 sec, then pull back 1 cm and repeat.

^ This is the way. 2% lido is a must. numb using a 25g spinal before placing 18g RFA needle has been huge in less tolerant patients. I used to do a few of these a week but now its maybe 2-3 a month since we only do this for medicare patients. for all others, we charge OOP and Ive been surprised, more patients than I expected have paid for this. If I know the insurance wont cover and patient is post TKA for example, we try 1 genicular nerve block on the insurance's dime since they typically pay for this then if went well, patient pays OOP for in clinic RFA. I offer it to them at the local surgery center but most opt against that when they see that it can be an almost 5 figure OOP cost with sedation, facility fee, etc. I agree with the above, typically a 20 minute procedure but can be 30 minutes if pt only tolerates RFA 1 needle at at time (had some loong afternoons because of this).

 

[Crybaby]

I got this message today attached to an approval letter. It is my first BC not to require appeals. Kind of exciting

IMPORTANT: Due to Anthem's positive Intracept policy and straightforward authorization process, beginning April 1, 2024, Anthem cases will no longer be accepted in the Relievant portal. You will be receiving more information in upcoming weeks regarding this change and we will ensure you are provided with the tools needed to obtain authorization for your patients.

 

[Tboned]

That happened awhile ago. Wish I had more Anthem patients in my area. Do you know if they have been reimbursing adequately for ASC?

 

[Ronin1]

I just had a Cigna approved. The guy did have to do the bs cpt though

 

[Taus]

I just had a Cigna approved. The guy did have to do the bs cpt though

They do get approved reliably. I use the telehealth company they rec’d. Pretty quick turnaround.

 

[painfree23]

How do you decide someone is a good intracept patient?

 

[SpineandWine]

How do you decide someone is a good intracept patient?

Bobs + 2 symptoms =\s