Hyperbare Zuurstoftherapie: Rapid Assessment - KCE

KCE Reports 74 Hyperbaric Oxygenation Therapy 85
6.4.3 Medicare charges for HBOT
6.4.3.1 Medicare Charges for physical supervision: Professional charge
Procedure code 99183 is billed for “physician attendance and supervision of HBOT, per
session”. The range of Medicare prices and limiting charges for code 99183 per session
in different geographical areas is as follows (Table 33): m
Table 33. Medicare prices and limiting charges for physical supervision
Non-Facility Facility Non-Facility Facility Limiting
Price Price Limiting Charge Charge
Min 162.73 99.42 177.79 108.62
Max 269.90 130.15 294.87 142.19
Avg 204.45 112.64 223.36 123.05
The Medicare physician fee schedule amounts are reflecting the variation in practice
costs from area to area. A geographic practice cost index (GPCI) has been established
for every Medicare payment locality for each of the three components of a procedure's
relative value unit (i.e. the RVUs for work, practice expense, and malpractice).
Medicare law places limitations on how much non-participating physicians / suppliers can
charge as fees for their services / supplies. Medicare refers to these limits as "limiting
charges". For participating physicians / suppliers a price is fixed depending from area to
area.
A supplier is considered a “Facility” when it performs services under the following
circumstances: n
• Inpatient or outpatient hospital settings
• Emergency rooms
• Skilled nursing facilities
• Ambulatory surgical centres (ASCs)
• Inpatient psych facilities
• Comp inpatient rehabilitation facilities
• Community mental health centres
• Military treatment facilities
• Ambulance (land)
• Ambulance (air or water)
• Psychiatric facility partial hospital
• Psychiatric resort treatment centres
All other settings are considered as a “non-facility”. In these settings a “non-facility
price” should be charged. Most small physician practices fall under this category.
6.4.3.2 Medicare Facility charges: Technical charge
According to personal communication with K. McIntyre from Wound Care and
Hyperbaric Medicine at Norfolk, the Medicare technical charge is around $600.00 per
treatment.
m Source: http://www.cms.hhs.gov/pfslookup/02_pfssearch.asp. Accessed in December 2007
n Source: http://www.providerpro.net/public/dka-g-medicare-110405.php Accessed in February 2008