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84 Hyperbaric Oxygenation Therapy KCE Reports 74 • Optimization of nutritional status, • Optimization of glucose control, • Debridement by any means to remove devitalized tissue, • Maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings, • Appropriate off-loading, • Necessary treatment to resolve any infection that might be present. Failure to respond to standard wound care occurs when there are no measurable signs of healing for at least 30 consecutive days. Wounds must be evaluated at least every 30 days during administration of HBO therapy. Continued treatment with HBO therapy is not covered if measurable signs of healing have not been demonstrated within any 30day period of treatment. 6.4.2 Non covered indications All other indications are not covered under the Medicare program. These include: • Cutaneous, decubitus, and stasis ulcers • Chronic peripheral vascular insufficiency • Anaerobic septicemia and infection other than clostridial • Skin burns (thermal) • Senility • Myocardial infarction • Cardiogenic shock • Sickle cell anaemia • Acute thermal and chemical pulmonary damage, i.e., smoke inhalation with pulmonary • Acute or chronic cerebral vascular insufficiency • Hepatic necrosis • Aerobic septicaemia • Nonvascular causes of chronic brain syndrome (Pick’s disease, Alzheimer’s disease, Korsakoff’s disease) • Tetanus • Systemic aerobic infection • Organ transplantation • Organ storage • Pulmonary emphysema • Exceptional blood loss anaemia • Multiple Sclerosis • Arthritic Diseases • Acute cerebral oedema
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
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