Insurance Billing CPT - Bio-Medical

Electromedical Products International, Inc.

2201 Garrett Morris Parkway

Mineral Wells, TX 76067-9034 USA

(940) 328-0788 Fax: (940) 328-0888

alpha-

email: alpha-stim@ 1.800.FOR.PAIN (367-7246)

in USA and CANADA

Insurance Billing for the Alpha-Stim?

PURCHASE Bill most claims, including Medicare, for the Alpha-Stim? 100 or Alpha-Stim? SCS under the CPT code E1399. This is the code for durable medical equipment not normally dispensed in an office visit. It is recommended that "Alpha-Stim 100 microcurrent stimulator" or "cranial electrotherapy stimulator (CES)" be written in for the description, rather than transcutaneous electrical nerve stimulation (TENS). The prescription must include a diagnosis of anxiety, depression, or insomnia for CES. The prescription should prohibit substitutions. Since E1399 is a by report (BR) code, the practitioner will have to accompany the form with a brief letter stating why this is being prescribed. For example:

To whom this may concern:

I am prescribing an Alpha-Stim 100 microcurrent and cranial electrotherapy stimulator for my patient, Jane Doe, for her intractable neck pain accompanied by anxiety. This device has shown to be consistently effective for her [the more specific details here, the better] and I have advised her to utilize it on an as-needed basis.

Yours truly, Dr. John Smith

If the primary diagnosis is pain, or Worker's Compensation, bill code E1399 for the Alpha-Stim? 100 or Alpha-Stim? PPM. If the patient is ordering extra electrodes, AS-TrodesTM are A4556 and ear clip electrodes are A4595. Lead wires should be billed as A4557. Replacement batteries are billed as A4630. Alpha Conducting SolutionTM is billed as A4558 and felt electrodes are A4595.

OFFICE VISITS Office visits utilizing the Alpha-Stim are a different matter. There are several possible codes a practitioner can utilize. The best ones are the physical medicine codes. Medical doctors, osteopaths, dentists, chiropractors, naturopaths, podiatrists, registered nurses, and physical therapists can use all the following codes (except 90899, which are for psychiatrists).

Code

Description

Time

Avg. Charge

97014 G0283

97032 90899 97535

Unattended electrical stimulation. Billed in 15 minute increments based on length of treatment. Medicare has specific coverage criteria.

Unattended electrical stimulation other than wound care, as part of a therapy plan of care. Billed in 15 minute increments based on length of treatment. Medicare has specific coverage criteria and prefers this code over 97014.

Attended electrical stimulation. Application of a modality to one or more areas. Recommended for inoffice treatments.

Unlisted psychiatric service or procedure. There is not a set fee schedule amount. Bill what you as the provider deem as your usual and customary charge based on length of service provided.

Self care/home management training; instructions in use of adaptive equipment, direct one-on-one contact.

15 min 15 min

15 min Inclusive 15 min

15.00 per unit 25.00 per unit

25.00 per unit 125.00 for treatment

40.00 per unit

Medicare Reimbursement

15.00 20.00

17.00 Not listed

30.00

Insurance Reimbursement

17.00 Not listed

22.00 Not listed

40.00

All codes listed above should be accompanied by an office visit 99201 - 99215, except Worker's Comp, which is 99455 for a physician or 99456 for personnel other than the treating physician. The more work a clinician does, and the more body parts treated, the greater the level of codes, and the more expensive the visit becomes. It is best not to exceed usual, customary, and reasonable ("UCR") fees for the area the practice is in, regardless of which combination of codes are used. The more UCR the codes appear, the greater the likelihood of the patient or practitioner being reimbursed. UCR is the general rule of thumb insurance companies live by. Everything must be UCR. The CPT codes, description, fees, ICD-9 (diagnosis), and even the total amount of the claim form being submitted must be UCR.

Medicare Reimbursement Calculation: Amounts listed are a national average. To find out the specific reimbursement for your area, log on to: cms.physicians/mpfsapp/display.asp or

A final word on insurance: The Alpha-Stim improves the quality-of-life of the person using it more than any competing device or drug. Don't sell it short! It is well worth the purchase price! Considering the 5 year warranty it is far less expensive than drugs and/or professional services. Use EPI's rent-to-own form for patient financing when there is no insurance or if the insurance company refuses to pay. Remember: Everybody needs an Alpha-Stim!

Cost Containment Analyses Between the Leading Anti-Depressant Drugs & Alpha-Stim? SCS? Cranial Electrotherapy Stimulation (CES) Technology

Cost of Treatment

Cumulative Cost of Treatment

Monthly Comparison of Anti-Depressant Drugs vs. Alpha-Stim? SCS Year One

$600

$400

$200

$0

PaxilTM ProzacTM ZoloftTM Alpha-Stim? SCS

Month Month Month Month Month Month Month Month Month Month Month Month

1

2

3

4

5

6

7

8

9

10

11

12

$83 $83 $83 $83 $83 $83 $83 $83 $83 $83 $83 $83

$137 $137 $137 $137 $137 $137 $137 $137 $137 $137 $137 $137

$115 $115 $115 $115 $115 $115 $115 $115 $115 $115 $115 $115

$495 $2 $27 $2

$2 $27 $2

$2 $27 $2

$2 $27

Month

$2,000

Comparison of Anti-Depressant Drugs with Alpha-Stim? SCS First Year

$1,500

$1,000

$500

$0

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month Month Month

10

11

12

PaxilTM

$83 $167 $250 $333 $416 $500 $583 $666 $750 $833 $916 $999

ProzacTM

$137 $273 $410 $546 $683 $820 $956 $1,093 $1,230 $1,366 $1,503 $1,639

ZoloftTM

$115 $229 $344 $458 $573 $687 $802 $916 $1,031 $1,146 $1,260 $1,375

Alpha-Stim? SCS $495 $497 $524 $525 $527 $554 $556 $557 $584 $586 $588 $614

Month

Five Year Cumulative Cost Average

$10,000 $8,000 $6,000 $4,000 $2,000 $0

PaxilTM ProzacTM ZoloftTM Alpha-Stim? SCS

Year 1 $999 $1,639 $1,375 $614

Year 2 $1,999 $3,279 $2,749 $735

Year 3 $2,998 $4,918 $4,124 $856

Year

Year 4 $3,998 $6,558 $5,499 $977

Year 5 $4,997 $8,197 $6,874 $1,098

Cost of Treatment

Savings

Cumulative 5 Year Savings Using Alpha-Stim? SCS Instead of Drugs

$8,000

$6,000

$4,000

$2,000

$0

AS vs. PaxilTM AS vs. ProzacTM AS vs. ZoloftTM

Year 1 $385 $1,025 $760

Year 2 $1,264 $2,544 $2,014

Year 3 $2,142 $4,062 $3,268

Year

Year 4 $3,021 $5,581 $4,522

Year 5 $3,899 $7,099 $5,775

? Copyright 2005 All Rights Reserved. Electromedical Products International, Inc.

Email: alpha-stim@ Web: alpha-

CL 3-10

Notes and References:

The Alpha-Stim? SCS is a prescription medical device classified as a cranial electrotherapy stimulator (CES) indicated for the treatment of anxiety, depression and insomnia. There are 126 human studies encompassing 6,007 research subjects and 29 animal studies of CES (Kirsch, Daniel. The Science Behind Cranial Electrotherapy Stimulation, Medical Scope Publishing Company, Edmonton, Alberta, 2nd Ed. 2002). Side effects are mild and self-limiting primarily consisting of headaches (0.20%) and skin irritation (0.11%). For complete prescribing information see product brochure.

The Alpha-Stim? SCS and accessories are manufacturer's retail prices from thealpha-.

The Alpha-Stim? SCS retail price is $495, with accessories calculated as follows: $15.00 for one pack of 200 felt electrodes and $10.00 for one 15ml bottle of Alpha Conducting SolutionTM per quarter and $1.75 for one 9 volt battery per month. It has a five year warranty.

Drug costs are from Brink, Susan. Health on the Border. US News & World Report, June 9, 2003, p. 55.

Monthly dosage and prices for drugs are: PaxilTM $83.29 for 30, 20 mg tablets, ProzacTM $136.62 for 30, 20 mg capsules, and ZoloftTM $114.56 for 30, 100 mg tablets.

Drug costs do not include ongoing physician visits to change drug prescriptions, adjust dosages, treat the side effects of drug therapy, or increasing drug costs over the five year period. _______________________________________________

Comparison of Treatment Efficacy Between CES & Drugs

Efficacy of Antidepressants Beyond the Placebo Response

Percent Improvement Over Placebo

70

60

50

40

30

20

10

0

PProrozzaacc5 5SStutuddieiess

Paxil P1a2xSiltudies ZoloftZo3loSftudies

12 Studies

3 Studies

EEffeffxexoorr6 6SStutuddieiess

Treatment

ZeSrezroznoene8 8StSutduideiess

CES 8CSEtSudies 8 Studies

References:

Kirsch I, Moore TJ, Scorboria A, and Nicholls SS. The emperor's new drugs: an analysis of antidepressant medication data submitted to the FDA. Prevention and Treatment. 2002;5:1-11. Available on the World Wide Web: rmation/Technology /Research/ Index /Costs/costs.html

Gilula, Marshall F., and Kirsch, Daniel L. Cranial Electrotherapy Stimulation Review: A safer alternative to psychopharmaceuticals in the treatment of depression. Journal of Neurotherapy 9(2):7-26, 2005.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download