US Reimbursement – Frequently Asked Questions

1. Is use of EDM covered by Medicare and other health insurers?

Medicare has determined that use of an esophageal Doppler monitor (EDM) is "reasonable and necessary" in two clearly defined patient populations (see below) and therefore eligible for professional reimbursement. Use of EDM is covered for:

• Monitoring of cardiac output (Esophageal Doppler) for ventilated patients in the ICU and
• Operative patients with a need for intra-operative fluid optimization

Some commercial insurers including Aetna and HealthNet (Include HyperLink to Policies) have also set positive coverage policies for this service.

2. How is use of EDM coded and reported?

CMS issued a Program Transmittal to all regional Medicare contractors indicating that CPT code 76999 (Unlisted ultrasound procedure) should be used to report EDM services. Specifically:

• "When performed in a hospital setting for ventilated patients in the ICU or for operative patients with a need for ultrasound diagnostic procedures, the professional services only are separately payable when billed using CPT code 76999 with the modifier -26 to show professional component"

The Medicare coding guidance is available at: http://www.cms.hhs.gov/transmittals/downloads/R76NCD.pdf

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