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US Reimbursement

Reimbursement

Deltex Medical’s CardioQ™ esophageal Doppler monitor (EDM) is a minimally invasive, evidence-based ultrasound technology used to optimize fluid levels in patients who are undergoing surgery or in intensive care.  Medicare, and some commercial insurers, provide coverage for EDM for specific patient populations and provide professional reimbursement for use of EDM.

Disclaimer: This information is provided by Deltex Medical as a guide for coding procedures and services involving Esophageal Doppler Monitoring. It is not intended to increase or maximize reimbursement by any payer. This information is intended to assist providers in accurately obtaining coverage and reimbursement for their health care services. Deltex makes no express or implied warranty or guarantee (i) that the list of codes and narratives is complete or error-free, (ii) that the use of this information will prevent differences of opinions or disputes with payers, (iii) that these codes will be covered, or (iv) that the provider will be guaranteed reimbursement. Providers assume full responsibility for all reimbursement decisions or actions. We strongly suggest you consult your payer organizations with regard to coverage and reimbursement policies.

 

Coverage

The Centers for Medicare and Medicaid Services (CMS) provides coverage for Esophageal Doppler Monitoring (EDM) under section 220.5 of the National Coverage Determination (NCD) Ultrasound Diagnostic Procedures. CMS determined that EDM is “reasonable and necessary” for all Medicare beneficiaries who meet the criteria for the following patient populations:

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

CMS’s decision was based in part on a technology assessment from the Agency for Healthcare Research and Quality (AHRQ) that concluded that in “patients undergoing surgical procedures with an expected substantial blood loss or fluid compartment shifts requiring fluid replacement” the clinical evidence for the use of EDM in the above patient populations was strong.

Disclaimer: This information is provided by Deltex Medical as a guide for coding procedures and services involving Esophageal Doppler Monitoring. It is not intended to increase or maximize reimbursement by any payer. This information is intended to assist providers in accurately obtaining coverage and reimbursement for their health care services. Deltex makes no express or implied warranty or guarantee (i) that the list of codes and narratives is complete or error-free, (ii) that the use of this information will prevent differences of opinions or disputes with payers, (iii) that these codes will be covered, or (iv) that the provider will be guaranteed reimbursement. Providers assume full responsibility for all reimbursement decisions or actions. We strongly suggest you consult your payer organizations with regard to coverage and reimbursement policies.

Coding

On April 1, 2013, CMS announced a unique code for professional services associated with the use of esophageal Doppler monitoring. The code (G9157 Transesophageal Doppler used for cardiac monitoring) is used to bill for professional services for using EDM.

CMS provided billing instructions to guide submission of claims.

(Previously CMS instructed physicians to bill professional services using 76999, the unlisted code for ultrasound diagnostic procedures).

We recommend contacting your payers for appropriate billing instruction and documentation requirements.

Disclaimer: This information is provided by Deltex Medical as a guide for coding procedures and services involving Esophageal Doppler Monitoring. It is not intended to increase or maximize reimbursement by any payer. This information is intended to assist providers in accurately obtaining coverage and reimbursement for their health care services. Deltex makes no express or implied warranty or guarantee (i) that the list of codes and narratives is complete or error-free, (ii) that the use of this information will prevent differences of opinions or disputes with payers, (iii) that these codes will be covered, or (iv) that the provider will be guaranteed reimbursement. Providers assume full responsibility for all reimbursement decisions or actions. We strongly suggest you consult your payer organizations with regard to coverage and reimbursement policies.

Payment

The 2015 national average Medicare payment level for G9157 is $97.97 (based on 2.74 RVUs). Professional services associated with EDM are separately payable under the Medicare Physician Fee Schedule (MPFS). Medicare adjusts professional payment based on regional differences in practice costs, thus payment may vary based on physician location. Other payers, including private payers, may base their payments on Medicare payment rates.

Physicians Fee Schedule

Disclaimer: This information is provided by Deltex Medical as a guide for coding procedures and services involving Esophageal Doppler Monitoring. It is not intended to increase or maximize reimbursement by any payer. This information is intended to assist providers in accurately obtaining coverage and reimbursement for their health care services. Deltex makes no express or implied warranty or guarantee (i) that the list of codes and narratives is complete or error-free, (ii) that the use of this information will prevent differences of opinions or disputes with payers, (iii) that these codes will be covered, or (iv) that the provider will be guaranteed reimbursement. Providers assume full responsibility for all reimbursement decisions or actions. We strongly suggest you consult your payer organizations with regard to coverage and reimbursement policies.

Support

Further information can be found here regarding payment and support or feel free to email: usreimbursement@deltexmedical.com directly.

Disclaimer: This information is provided by Deltex Medical as a guide for coding procedures and services involving Esophageal Doppler Monitoring. It is not intended to increase or maximize reimbursement by any payer. This information is intended to assist providers in accurately obtaining coverage and reimbursement for their health care services. Deltex makes no express or implied warranty or guarantee (i) that the list of codes and narratives is complete or error-free, (ii) that the use of this information will prevent differences of opinions or disputes with payers, (iii) that these codes will be covered, or (iv) that the provider will be guaranteed reimbursement. Providers assume full responsibility for all reimbursement decisions or actions. We strongly suggest you consult your payer organizations with regard to coverage and reimbursement policies.