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Uroplasty Reimbursement Group
5420 Feltl Road
Minnetonka, MN 55343
Tel: 866.258.2182
Fax: 866.344.0219
reimbursement@uroplasty.com

Disclaimer: Uroplasty assembled this coding, coverage and payment information as a convenient reference source. It is subject to change without notice as a result of changes in reimbursement laws, regulations and policies. This content is informational only and does not address all possible situations. No guarantee or promise of coverage or payment is represented herein. Providers assume full responsibility for accurate coding and reimbursement decisions and actions. All procedures and services should be accurately documented in the patient’s medical record. Please consult your payer organization if you have questions regarding its specific reimbursement guidelines.

Welcome to MPQREIMBURSEMENT.COM!

Here you will find information and resources to assist you in the claims submission process for a urethral bulking procedure using Macroplastique®.

Macroplastique is indicated for transurethral injection in the treatment of adult women diagnosed with stress urinary incontinence (SUI) primarily due to intrinsic sphincter deficiency (ISD).   Additional information about Macroplastique is available on the Macroplastique Product Page.

If you are looking for coding, coverage or payment information for Urgent® PC, please visit www.urgentpcdevicecoding.com.

If you would like to speak to someone directly, please contact the Uroplasty Reimbursement Group at 866-258-2182.

Macroplastique common CPT® codes using CMS 1500 Forms for physician and UB04 Form for facilities (ASC and Hospital): HCPCS code L8606 should be used to bill for Macroplastique implants in the physician office. Providers do not need to be a DME supplier and should bill their local Medicare carrier.

ICD-9 CM – DIAGNOSIS CODE
599.82       Intrinsic sphincter deficiency (must appear as primary diagnosis on all claims for reimbursement)

PHYSICIAN CODING OPTIONS – IN OFFICE
SITE OF SERVICE 11

Note: the 2010 Fee Schedule will go into effect March 1, 2010.


CPT®-4 Code1

2009 Medicare National Allowed Amount2, 3

51715- Endoscopic injection of implant material into the submucosal tissue of the urethra and/or bladder neck

$278

HCPCS Code

L8606- Synthetic implant urinary 1ml4

$178 - $2385
Per ml

Note: HCPCS Code L8606 is for 1 ml. Two syringes of Macroplastique®
(5 ml) are required for each procedure.

PHYSICIAN CODING OPTIONS – IN FACILITY
SITE OF SERVICE 22

Note: the 2010 Fee Schedule will go into effect March 1, 2010.


CPT®-4 Code1

2009 Medicare National Allowed Amount2, 3

51715- Endoscopic injection of implant material into the submucosal tissue of the urethra and/or bladder neck

$184

AMBULATORY SURGICAL CENTER (ASC)
CODING OPTIONS

CPT®-4 Code1

2010 ASC Medicare Allowed Amount 2, 6

51715- Endoscopic injection of implant material into the submucosal tissue of the urethra and/or bladder neck

$1,064

HOSPITAL OUT-PATIENT CODING OPTIONS

CPT®-4 Code1

2010 Hospital
Outpatient Medicare Allowed Amount 2

51715- Endoscopic injection of implant material into the submucosal tissue of the urethra and/or bladder neck

 $2,115
APC Code
0168 NA
C-Code
C2631- Medicare is using 2631 to gather device cost information for future rate-setting purposes. No additional payment will be rendered to the hospital NA

Contact your local carrier/payer to determine correct coding, coverage and
payment policies. All rates shown are the 2009 and 2010 Medicare National Average;
actual rates will vary geographically.

  1. CPT® is a trademark of the American Medical Association. Current Procedural Terminology (CPT) is a copyright 2008 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listing are included in CPT.
  2. "Amount Allowed" is the amount Medicare determines to be the maximum allowance for any Medicare covered service. Actual payment will be based on the maximum allowed less any applicable deductable, coninsurance, etc.
  3. Physician payments calculated using the 2009 conversion factor of $36.0666 and mandated budget neutrality work adjuster of 89.895 (Federal Register, November 19, 2008).
  4. In the physician office setting, the Medicare Part B Contractor has jurisdication for this implantable prosthetic device (CMS Transmittal 893, CR 4363, March 24, 2006).
  5. 2010 Durable Medical Equipment Prosthetics/Orthotics and Supplies Fee Schedule (DMEPOS). Source: www.cms.hhs.gov/DMEPOSFeeSched/LSDMEPOSFEE/list.asp.
  6. ASC rates are from the 2010 Ambulatory Surgical Center Covered Procedure List - Addendum AA. Source: November 20, 2009, Federal Register.

 

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