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 that apply only to the hospital outpatient setting and the ambulatory surgery center settings. 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
Contact the Vituro Health Care Center for more information regarding HIFU and medicare.