VITURO HEALTH MEDICARE ELITE ACCESS PROGRAM

Effective July 1, 2017 Medicare issued a Temporary C-Code C9747 for facility coverage ONLY.

  • As of today, most MACS are reimbursing, making the out-of-pocket cost to a patient somewhere between $11,000 and $13,000. This is something we monitor closely with each jurisdictional MAC.
  • Facilities covered are Hospital Outpatient Facility or Ambulatory Surgery Center (ASC)
  • C9747, for the ablation of the prostate, transrectal, high intensity focused ultrasound (HIFU) including imaged guidance.
  • This procedure being assigned a HCPCS code and a payment rate under the OPPS does not imply coverage by Medicare.
  • Assigns a value if the Medicare Administrative Contractor (MAC) determines it meets requirements for coverage. (11 MACS)
  • MACs make determination for all settings – Hospital, ASC and HOPD

WHAT IS A C-CODE?

  • C-codes are unique temporary pricing codes established by CMS, and apply only to the hospital outpatient setting, while some C-codes also are payable in the ambulatory surgery center setting. They are separately payable and should be reported and billed together with the appropriate current procedural terminology or health-care common procedure coding system code.

WHAT DOES CODE C-9747 COVER?

  • Facility (hospital, ASC or outpatient facility)- where the procedure is performed.

WHAT DOES MY OUT-OF-POCKET COSTS COVER?

  • Vituro Health HIFU physician-who performs the HIFU procedure.
  • Anesthesiologist-delivers anesthesia
  • Vituro Health Patient Advocacy Center

Please contact the Vituro Health Care Center for more information.

Contact insurance@viturohealth.com

 

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