Two pain management techniques were addressed specifically in the 2015 Medicare Fee Schedule released in display form on October 31, 2014.
For the first time, transversus abdominis plane (TAP) blocks administered for post-operative pain control will have specifically identified codes for claims submission.
Previously, anesthesia and pain providers had to use generic injection or infusion codes to capture this service. Now, the American Medical Association/Specialty Society Relative Value Scale Update Committee, or RUC, has adopted four new CPT© codes, and for the first time, these codes have been included in the Medicare Physician Fee Schedule for reimbursement for dates of service on or after January 1, 2015.
The new codes are differentiate between injection and infusion, as well as between unilateral or bilateral.
- 64486 – Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)
- 64487 – Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) unilateral; by continuous infusion(s) (includes imaging guidance, when performed)
- 64488 – Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)
- 64489 – Transversus abdominis plane (tap) block (abdominal plane block, rectus sheath block) bilateral; by continuous infusions (includes imaging guidance, when performed)
In 2014, the Centers for Medicare and Medicaid Services reduced payment for epidural pain injections under the misvalued code initiative. In response to concerns from pain physicians regarding the accuracy of the valuation, however, CMS proposed to raise the values in 2015 back to their 2013 level while RUC continues to evaluate the services.
In the meantime, because it was clear to CMS that image guidance, such as the radiographic fluoroscopic room, are included in the 2013 fee formula for the epidural injection codes, they determined to prohibit separate reporting of image guidance codes that would overestimate the resources used in furnishing the service.
According to CMS, the “two-tiered” approach of utilizing CY 2013 input values while prohibiting separate billing of imaging guidance best ensures that appropriate reimbursements continue to be made for these services until RUC can further review this issue and make recommendations.
For more information about these changes and additions, review the display copy of the 2015 Medicare Physician Fee Schedule.
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