Is the end near for heat therapy?
LOUDON, Tenn. - CMS seems intent on "killing the code" for heat therapy units (E0217) by reducing reimbursement for the products to a pittance, says Scott Gammons, vice president of Adroit Medical Systems.
The reason: Between 2004 and 2009, reimbursement for the product exploded, rising from $3.4 million to $25 million thanks to very lenient product coding, said Gammons, whose company makes an FDA-approved water-circulating heat therapy system.
In short, due to loopholes in coding (no CMN is required to bill for these products, nor do they need FDA approval), many companies took advantage of the system, selling providers inexpensive products that maximized reimbursement and sent utilization sky-high, he said.
As a result, in a recent LCD, CMS stated that the product is not "reasonable and necessary" for treating chronic pain. Beginning April 1, most E0217 claims will be down coded to an electric heating pad. That means reimbursement will drop from about $521 to "$20 or something like that," Gammons said.
For Adroit's product, which wholesales for about $300 (other units sell for $200 or less), the down coding spells death. Fortunately, the company also operates a large OEM business, Gammons said.
Adroit has protested the LCD, trying to make the point that its FDA-approved product is the "first line of defense" when it comes to a drug-free treatment for chronic pain.
"I understand their philosophy, but, you don't cure cancer by killing the patient," he said. "You target the cancer. You cut it out. You treat it. You do what you can to help the patient recover."