Facility fee decrease for implants (63685)

Started by lmsanscafe
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

lmsanscafe

Full Member
10+ Year Member
Advertisement - Members don't see this ad
Has there been a cut in facility fee reimbursement for IPG implants (CPT 63685)? Searching for the medicare amount now indicates it's around $9k, whereas even a few weeks ago it was around $29k. Any insight from those who may know more would be appreciated.
 
Last edited:
Advertisement - Members don't see this ad
Are you getting push back on scheduling a Medicare IPG replacement? The ASC can try to work something out with the vendor. I recall when I first started the surgery center said they would be doing the IPG at a loss. The batteries are just priced really high.
 
IMG_0284.jpeg
 
Please pardon my ignorance. I see "non-facility (office)" vs "facility (ASC/hospital)". Aren't both of these considered "professional fees"? Isn't there another fee that is paid to the ASC aka the "facility fee"?