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Medicare eliminates most peripheral nerve blocks
Started by Agast
This is just proposed for now, right?
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There's a reason why a lot of these blocks aren't covered by private insurance - there is not a lot of research done showing therapeutic efficacy. We've just done these injections "since the dawn of time" and enjoyed grandfathered status. Now CMS is trying to save money and this is the lowest hanging fruit. I would be surprised if the procedures survive.
So back to what supposed KOLs could do for us - they could be doing the research trials that help us hold on to the non-device procedures that help our patients.
cant use steroid with trigger points, so difficult to get good results "for occipital blocks"
KOLs only exist in the context of expensive devices and kits. Outside of that setting, they simply don't exist. Poof!
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This forces docs to offer these for cash.
If people truly get relief and it's worth it, they'll come.
It could end up being a good thing.
If people truly get relief and it's worth it, they'll come.
It could end up being a good thing.
but you can't use steroid in TPI, so you're getting great effectiveness with just local?
Marvelous comment
For those in HOPD settings, keep billing the nerve blocks and their CPT codes. It can sometimes take YEARS before the billers catch on. Meanwhile you still get the RVUs bc eff the hospital. Btw, they will never love you back
Is there and alternative (NOS) code that might get paid?
Occipital are the one that come to mind but hip shoulder and knee blocks pre-RF are a big deal. No LFCN blocks. No inguinal blocks.
No bueno
I wonder if there is a loophole where you wouldn’t classify these for ‘chronic pain’. Anesthesiologists will still be doing femoral nerve blocks prior to a TKA, for example
Is there and alternative (NOS) code that might get paid?
Occipital are the one that come to mind but hip shoulder and knee blocks pre-RF are a big deal. No LFCN blocks. No inguinal blocks.
No bueno
I wonder if there is a loophole where you wouldn’t classify these for ‘chronic pain’. Anesthesiologists will still be doing femoral nerve blocks prior to a TKA, for example
The LCD may say there is no therapeutic benefit, but it’s harder to say there is no diagnostic benefit
You could arguably do a diagnostic peripheral nerve block to determine peripheral vs radicular pain generator, plus steroid, unless the LCD specifically addresses the diagnostic component.
The CPT codes will still exist
You could arguably do a diagnostic peripheral nerve block to determine peripheral vs radicular pain generator, plus steroid, unless the LCD specifically addresses the diagnostic component.
The CPT codes will still exist
hyperalgesia when a little old lady with her $1800/mo Social Security check walks through the door...
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great idea. Maybe some dex will accidentally slide into a dx block. Humans do make mistakes after all.
Of course.
Occipital blocks with 0.5% ropi is a great injection for chronic migraines, occipital headaches, whiplash, etc.
I do a TPI in the traps, cervical paraspinals, greater and lesser ONB.
Takes me no time to do it, and patients get good results from it. Start doing these more often. Need a driver because bilateral ONB can cause dizziness, but extremely rarely.
And it looks like we can still do ablations. I have a gentleman that comes once a year and I bipolar his cluneal nerves on one side. Comes to visit his daughter and stops in while here. Ohio resident.
Darn, you are correct. Cash it is.
Dont worry they will still cover percocet!
.. oh wait, write too much of that (bc no one other than the pain doc can write it) and you will be blacklisted by the pharmacy!
.. oh wait, write too much of that (bc no one other than the pain doc can write it) and you will be blacklisted by the pharmacy!
I do the same thing. A lot
Yeah like a lot more…
Yep, government in action. They’ll eliminate the cheap options so everyone will try to kill a gnat with a bat and stim everyone.
It said thoracic nerve. Couldn’t that be intercostal blocks?
Maybe thoracic RFA will still be covered?
I can’t believe the stupidity to stop covering genicular RFA. I already don’t offer those because bad pay, but they make life more bearable for many patients.
My big concern is if Medicare stops covering all those nerve blocks then next year all the commercial payors will stop covering them too.
Does anyone still cover occipital nerve blocks? I though some of the BCBS plans still did ?
Even though medial branches of the NRs are technically peripheral nerves, I think they would have been specifically mentioned if they were included in this purge.
I like these too. Better results than lumbar RFA in my patients.
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agree. They are going after the low hanging fruit first.
Here’s hoping T_T
Time to start stimming everything. Better get my pointy shoes ready.
Wish I had fully funded an HSA to pay for all of the procedures I may need in the future....
http://-scientific-announce-agreement-to-acquire-nalu-medical-inc-302587495.html
Boston Scientific Announces Agreement to Acquire Nalu Medical, Inc.
Reps sending me news that Boston is going all in on PNS, timing seems suspect given recent LCD changes. Coincidence?
Boston Scientific Announces Agreement to Acquire Nalu Medical, Inc.
Reps sending me news that Boston is going all in on PNS, timing seems suspect given recent LCD changes. Coincidence?
This will backfire as Medicare will likely not cover PNS much longer. Didn’t they already lose a bundle of money on Vertiflex?
I think they probably lost money, Vertiflex fell out of favor soon after the purchase. In addition, Stryker now has competitive pricing for their BVN ablation system so we may stop using Intracept.
I think everyone lost on vertiflex. The original investors would have been better with their money in the market from 2008 to whenever they sold.
Has anyone used the Stryker system? I’ve only done 5 cases so far but pretty happy with the rep and prior auth support from BoSci
Have you seen actual pricing from Stryker’s yet?
Same question
We just received information on the differences between the systems and a quote from Stryker, it’s only a small amount cheaper, hopefully with further discussions we can get even better pricing. We have had some issues with the intracept reps no showing or arriving late for cases, so changing vendors is definitely on the table.
I can send you specifics if you want to DM me.
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Dm is not showing up as an option for you, but it is for everyone else on this thread.
Not sure why, sent you a message
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I got your message. Thank you.
It is ridiculous that Stryker is only willing to do 3-4% cheaper than intracept. I wouldn’t bother switching equipment reps, etc, unless they came in a minimum of 20% lower cost.
Does stryker have the same 5-case line up training requirement to use their product?
Cool, I'll go straight to Sprint PNS, and skip the nerve block. Thanks MCR!
I agree, I am going to bring this up with Stryker. They will need to make a more competitive offer for us to switch.
