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Posted by John King on 7/18/04 at 08:47 (155740)

Does Medicare pay for ESWT?

Re: Medicare

Dr. Z on 7/18/04 at 09:11 (155745)

This depends on the carrier that is providing Medicare. There is no national policy

Re: Medicare

Janice N on 7/18/04 at 15:38 (155769)

I am still researching it for my area. I was preapproved supposedly as posted before. Then got a letter fom Medicare saying it wasn't covered.
Since I wasn't given a form to sign in the office saying it might not be covered I am noy suppose to pay for it. But I am waiting to find out. The dr said the is three ways to code it. I tired to look online for my carrier and see what it says but haven't found it yet.

Re: Medicare

Pauline on 7/18/04 at 20:21 (155788)

I find your post interesting because Dr. Ed one of our resident Pods have posted the temporary code available for ESWT on this site in the past.

Now you're saying that your doctor says there are THREE ways to code it.

I guess the next question goes to our resident Pods. What happened to the temporary code that everyone was using, and how is it Janice's doctor has 3 to choose from than the rest of you?

Re: Medicare

Ed Davis, DPM on 7/19/04 at 09:36 (155818)

The official code remains 0020T. It is known as 'temporary' CPT code.
Occasionally an insurer requests that a different and specific code be used and the doc is obliged to comply. That code could be a code for an 'unlisted procedure' but should not represent anything else.

Re: Medicare

Janice N on 7/19/04 at 11:12 (155827)

That was the drs answer when he called in reply to my letter to his office. That it could be coded under three different ways. And who was I say to no it isn't if I didn't know. He is the one that would be out the 1,000 bucks because it was billed through his office. Now I am hoping it is something in the code. And I can say from personal experience that wrong codes get used all the time and have to be redone. I am sure I will be finding out real soon. He will be here I think next week to see patients in my building and I will make an appointment to see him. If we both agree I need ESWT again I sure won't get it if he doesn't get paid for it.