CMS SUPPLY NUMBER RATE REDUCTIONS FOR 2019 LOWEST FOR CLARIVEIN
By Larry Storer
The Centers for Medicare & Medicaid Services issued a final rule Nov. 1, 2018, that includes updates to payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule on or after Jan. 1, 2019.
The effect of CMS changes to the supply numbers for the major technologies used in vein surgeries show significant reductions in reimbursement rates for all technologies except the changes for MOCA (ClariVein), which only slightly decreases compared to larger decreases for laser and Radiofrequency ablations
All Current Procedural Terminology (CPT) codes are comprised of a malpractice component, physicians work, and for Non-facility payments and supply cost. Various supplies are included in the makeup of the supply cost and each has a code and cost associated. A change in these supply costs will affect the overall reimbursement for the code.
Clarivein, which is marketed by Vascular Insights, is assigned the all-inclusive code designated for MOCA, which is 36473. This CPT code is for closing a single incompetent extremity truncal vein; for example, the great saphenous vein or an accessory saphenous vein in people suffering from symptomatic venous reflux or varicose veins. It also uses CPT Code 36474 for additional veins treated in the same leg. These codes include all supplies, including the sclerosant.
Radiofrequency ablation and laser ablation revenue reductions will apply to all physicians using RF or laser procedures, regardless where the technology was purchased.
Radiofrequency Ablation, CPT Code 36475: $1,463.19 or a 5.6% decrease. The second access for Radiofrequency, CPT Code 36476: $308.13 or a 2.4% increase.
Laser Ablation, CPT Code 36478: $1,156.86 or a 6.4% decrease. The second access, CPT Code 36479: $325.43 or a 2.4% increase.
MOCA, by comparison, is: CPT Code 36473: $1,492.02 or a 3.2% decrease. The second access, CPT Code 36474: $283.63 or a 0.1% increase.
Changes to the CMS Supply Numbers will be implemented incrementally over the next four years beginning Jan. 1, 2019.