New ostomy codes: less than perfect

Sunday, March 16, 2003

March 17, 2003

WASHINGTON - The final version of Medicare's new ostomy codes increases reimbursement on 75% of the codes by 30% to 40% and decreases reimbursement on the rest about 4%. That 3 to 1 split is good news, but not that good, said Linda Aukett, spokeswomen for the United Ostomy Association (UOA).

For two of the most popular codes in the ostomy universe - A5063 (drainable ileostomy pouch) and A5073 (urostomy pouches) - CMS did not increase reimbursement. That's a problem because the fee schedule price for these widely used products is too low, Aukett said.

" The dealers are less likely to accept assignment on them," Aukett said. "Some dealers will be more likely to put (beneficiaries) into product where they can get higher reimbursement. That is just the nature of the beast."

To boost reimbursement on A5063 and A5073, the UOA may ask CMS for an inherent reasonableness (IR) review of the products in these codes, with the hope that it would lead to an increase in reimbursement, Aukett said.