http://www.goremedical.com/en/file/AJ0554.pdf
Lists national medicare info for hernia repairs...including CPT code, and reimbursement. I kinda got dizzy reading the tables (they give inpt and outpt tables).
But if you scroll to page 5, you'll see their examples. Based on what i see from this table, the mesh implantation itself does not lead to additional compensation for the surgeon vs a non-mesh repair....even the hospital doens't get paid more for using the device.
I'm learning too, but here is as I understand it:
Do not confuse what the physician charges with hospital charges. So using the table on page 5:
CPT Code 49561 (incarcerated hernia):
- the physician is reimbursed the same amount of money ($820) whether he does it in a facility (ie, hospital) or non-facility (ie, his office..not that he would do it there)
- if the patient is inpatient, the hospital collects $4599 for this DRG group
- if the patient is outpatient, the hospital collects $1796
- if done in an ASC, the reimbursement is (to the ASC, of which you may be part owner): $1339
Now if you add implanting the mesh (CPT 49568):
- the physician garners another $250 (although as I noted above, it will be discounted as a multiple procedure modifier)
- the hospital gets no more for the procedure because its bundled into the DRG (although they can charge for the mesh itself)
- the outpatient reimbursement to the hospital facility is:$898
- for the ASC its $497. All of which are added to the reimbursement for the procedure.
So it all works out that the physician in PP who owns the ASC gets the most because you can charge professional and facility fees.
The concept of DRGs is why you will often hear from your radiology friends that they won't get paid if they do that CT/MRI etc for a patient who is in-house and could have it done as an outpatient.