Medicare has finally issued a facility billing code to cover much of the cost of HIFU (high-intensity ablation of the prostate gland) in the treatment of prostate cancer. HIFU is an alternative primary treatment option available to men with prostate cancer that is still confined to the prostate gland.
The Centers for Medicare and Medicaid Services (CMS) issued a C-code, C9747 in July for HIFU. C-codes are a part of the CMS standard coding system, called the Healthcare Common Procedure Coding System or HCPCS.
C-codes are unique temporary codes that are only valid for Medicare claims for procedures performed in a hospital's outpatient facility or in an ambulatory surgery center.
This code can not be used for the reimbursement of any procedures completed in a doctor's office or for the actual services provided by a physician. This new code will only provide reimbursement to the hospital or ambulatory surgery center.
This code does not apply to commercial insurers; therefore if you are not covered by Medicare you should first speak to your insurance company for clearance or expect to pay for the treatment yourself.
For more information on reimbursement and coding visit https://www.hifuprostateservices.com/reimbursement/.
Joel T. Nowak, MA, MSW wrote this Post. Joel is the CEO/Executive Director of Cancer ABCs. He is a Cancer Thriver diagnosed with 5 primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma and a rare cancer, Appendiceal Cancer.