Reimbursement for Use of the Intrector® System (Insight Instruments)

This monograph addresses the reimbursement issues associated with the Intrector® System, which allows surgeons the flexibility to perform a vitrectomy in a variety of settings including the office.  Three different aspects of reimbursement are considered:  coding, physician payment, and facility payment.

Over the past 25 years, many hospital-based procedures have migrated to the outpatient ambulatory surgical setting for the added convenience and cost savings. As an extension of this trend, some procedures that are now commonly performed in an ASC or HOPD are moving to the physician’s office when patients are medically stable, procedure times are short, no regulatory obstacles exist, and the instrumentation is suited for a minor procedure room.

Much of the information is taken from the official publications of the Medicare program, including the Centers for Medicare and Medicaid (CMS) and the Medicare Administrative Contractors (MAC).  However, the reader is encouraged to check with the local MAC for additional information and instructions.  In the case of other third party payers, we have used the coding concepts contained in the Current Procedural Terminology (CPT), published by the American Medical Association; diagnosis codes are from ICD-9-CM.  Documentation of the medical necessity of the procedure is a prerequisite to reimbursement, so we describe the required elements in detail.

Since economic analyses are a necessary part of any purchasing decision, we incorporated Medicare’s payment rates for the salient procedures as well as available utilization rates.


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