Celleration, Inc.

REIMBURSEMENT
Reimbursement Information for the MIST Therapy^® System

Reimbursement Hotline

1.866.307.MIST (6478) select option #3

Coding of MIST Therapy

A new Category III CPT¹ Code for low frequency, non-contact, non-thermal ultrasound is effective January 1, 2008.

0183T

Low frequency, non-contact, non-thermal ultrasound, including topical application(s) when performed, wound assessment, and instruction(s) for ongoing care, per day

Celleration encourages all providers to use CPT 0183T when coding for MIST Therapy.

Per the AMA, "Since Category III codes are part of the CPT code set, all health care payers must be able to accept Category III codes into their systems to comply with the standards for transactions and code sets under HIPAA."² Category III codes are temporary codes for emerging technology, services, or procedures, that allow physicians and other qualified healthcare professionals, insurers, health care researchers, and health policy expects to identify emerging technology, services and procedures for clinical efficacy, utilization and outcomes.

Providers may determine it is appropriate to use MIST Therapy in conjunction with or adjunctively to other wound care procedures (e.g., surgical or sharp debridement). CPT coding for other wound care procedures are found in CPT Coding Guides and are often listed in a payer’s wound care coverage policy.

Payment of MIST Therapy

Payment of MIST Therapy will vary according to each payer’s fee schedules, payment methodology, and the care setting. For Medicare, published payment rates are shown below. Common care settings for MIST Therapy include Hospital Outpatient departments, other free-standing outpatient clinics, and inpatient settings.

Hospital Outpatient Wound Clinic

2008 Medicare Ambulatory Payment Classification for 0183T³
APC 0015 Level III Debridement & Destruction $92.96

Medicare payment rules for wound care in the Hospital Outpatient setting state "When hospital outpatients receive wound care services by individuals outside of a certified therapy plan of care, the hospital reports the appropriate CPT code and nontherapy revenue code and is paid under the OPPS."⁴

Hospital Outpatient Physical Therapy / SNF Outpatient Physical Therapy

Each local Medicare contractor sets the CPT 0183T payment rate for the Physical Therapy department using the Medicare Physician Fee Schedule (MPFS) for wound care services performed by a qualified therapist under a therapy plan of care.⁵

Other Free-Standing Outpatient Clinics / Physician Office

Each local Medicare contractor sets the payment rate for 0183T on the Medicare Physician Fee Schedule.

Inpatient Settings

In most inpatient settings, such as inpatient Hospital, LTACs, and SNFs, Medicare payments are prospective payment rates. Providers can document use of MIST Therapy with CPT 0183T procedure code, and appropriate equipment codes (e.g., A9900 Supply/accessory/service, A9999 DME supply or accessory, and/or E1399 DME miscellaneous).

Coverage of MIST Therapy

MIST Therapy may be covered and separately payable based on each payer’s local coverage guidelines. Consult your facility’s reimbursement department or the payer for information on coverage of wound care services including CPT 0183T for MIST Therapy.

1	Current Procedural Terminology or CPT is a trademark of the American Medical Association (“AMA”).
2	AMA Website, http://www.ama-assn.org/ama/pub/category/3882.html
3	2008 Medicare Hospital OPPS Final Rule, Addendum B.
4	Changes to the Hospital OPPS and CY 2008 Payment Rates, CMS-1392-FC, p929. See also January 2006 Update of the Hospital OPPS, CMS Transmittal 804, CR 4250, pp 28-29 and Medicare Claims Processing Manual, Chapter 5 – Part B Outpatient Rehabilitation and CORF/OP Services, Section 20.
5	Changes to the Hospital OPPS and CY 2008 Payment Rates, CMS-1392-FC, p929: "When these [wound care] services are provided to hospital outpatients by a qualified therapist under a therapy plan of care and reported using either one of the appropriate therapy modifiers, the therapy revenue code series (42X, 43X, or 44X), or both, hospitals are paid based on the MPFS."

THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT ADVICE ABOUT HOW TO CODE, COMPLETE OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. ALTHOUGH CELLERATION SUPPLIES THIS INFORMATION TO THE BEST OF ITS KNOWLEDGE, IT IS ALWAYS THE PROVIDER'S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS AND BILLS FOR THE SERVICES THAT WERE RENDERED. PAYERS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE FILING ANY CLAIMS, PROVIDERS SHOULD VERIFY THESE REQUIREMENTS WITH THE PAYER.