Responses: WalkAide Reimbursement

Posted By: Scott Freeman on March 26, 2009

Thank you to all that responded.



Regards,



Scott Freeman



Original Post:

Since the WalkAide received a CMS reimbursement code which was
supposedly effective January 1, 2009, has anyone submitted for
reimbursement of the device or are patients still paying out of pocket
for it? If you have submitted for reimbursement what is the
reimbursement level for the WalkAide? I have contacted CMS on several
occasions with no avail. Thank you so much for your help.

Scott Freeman

Responses:



There are certain guidelines that have to be followed. The walk Aide
people should fill you in on what you need to do. They want to do all
the billing for you. The code issued by Medicare is a broad based code.



remember medicare will only approve walkaide for spinal cord injuries
and documentation is very strict. I haven't tried billing but diagnosis
is key



My understanding is the E-code is valid only for peripheral nerve injury
cases and not for upper motor neuron pathologies as it is intended to be
used for. Please validate this with IN, however when I spoke with them
early this year that was their interpretation of the HCPC coding
literature.

Therefore the ICD-9 code has a range restriction to pathologies which
are not meant to be treated with this device. Apparently it has
something to do with lumping this device in with a competing technology
that is indicated for peripheral lesion conditions.



You need to contact Innovative Neurotronics. They are submitting to the
insurance companies on our behalf. They have a whole packet of info
that needs to be filled out on each patient. We have not yet had an
insurance company pay for it, but I have about 4 pending with
Innovative. Currently we are having the patients still pay, and if we
get reimbursed we will reimburse the patients.



e code is e0770 and medicare will reimburse only for spinal cord
injuries. there are other requirements as well such as pt must have 32
pt appts, a lot of documentations and so for. innovative neurotronics
now has a department which will predetermine patients benefits for ur
patient. it takes approx 10 to 30 to get the predetermination. inn inc
lists the walkaide fot over 8grand so that well get approx 4500 to 5000
after insurance discounts. if a patient is paying out of pocket the
list price should be 4520. electrodes are extra.



I don't do walkaid business but is this one of those scenarios where
Medicare gave us a code without a $ amount. They have the O&P community
submit reasoning for their price over a trial period like all of 2009
before they establish a price for the code? Remembering back when we
received the L code for the rocker sole there was no reimbursement
amount attached. We had to send in an amount and reasoning why we would
bill that $. Since I do mostly prosthetics I am not even sure if we
have an amount for the rocker code.






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