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OMNISENSE 7000S/8000S
Reimbursement
| Reimbursement | |
| Bone strength
assessment with Omnisense 7000S/8000S may be a covered service, if it
meets the requirements established by Medicare and private payers. It is
always recommended that you check with your local Medicare contractors and
private health plans regarding their local coverage policies. |
|
| Coding Requirements | |
| Codes are
necessary for physicians and freestanding clinics to report their services
and procedures. Accurate coding may lead to faster processing of submitted
claims. In the absence of a national coding policy it is advisable to
check with your local Medicare contractors or private insurance plans
regarding their accepted coding policy. A submission for payment requires
two codes for each procedure, a diagnosis code (ICD-9-CM) and a procedure
code (CPT). |
|
| ICD-9-CM | |
| To comply with
Medicare and third-party payer requirements, claim forms must indicate the
ICD-9-CM code or codes that describe the principal diagnosis responsible
for the patient's condition. Sunlight has compiled a suggested list of
ICD-9-CM codes that may relate to the Omnisense 8000S bone strength
assessment test. Some carriers may have a specific list of ICD-9-CM codes.
It is advised that you contact your local carrier to obtain its current
policy. |
|
| CPT Coding | |
| Physicians'
Current Procedural Terminology (CPT), Fourth Edition, is a listing of
descriptive terms and identifying codes for reporting medical services and
procedures that physicians and other medical professionals perform. The
purpose of CPT is to provide a uniform language that accurately describes
medical, surgical, and diagnostic services, thereby serving as a means for
nationwide communication among physicians, patients, and third parties.
The CPT code used for bone assessment with Omnisense is CPT Code 76977
(Ultrasound bone density measurement and interpretation, peripheral site(s),
any method). CPT is a trademark of the American Medical Association (AMA). The AMA assumes no liability for the information contained herein. |
|
| Billing Requirements: Documentation | |
| Documentation is
the key to providing a carrier with the information necessary for making a
decision whether to approve or deny a claim. Essential medical information
should include documentation that Sunlight Omnisense™ 7000S/8000S was
used to assess the patient's bone strength in accordance with approved
indications. |
|
| Insurance Procedures | |
| Sunlight has
prepared a list of procedures for insurance coverage for patients covered
by Medicare and patients covered by private insurers. |
|
| The coding, coverage, and payment information contained herein is gathered from third party sources and is subject to change. The codes listed are possible coding options. It is always the provider's responsibility to determine and submit appropriate codes, charges, and modifiers for the services that are furnished. Providers should contact their local payers for specific information on pertinent coding, coverage and payment policies before a claim is submitted. Sunlight Medical Inc. cannot guarantee success in obtaining payments for medical services. | |
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