Medicare Benefits Schedule - Note TN.8.244

As with all interventions, implant procedures should be performed in the context of clinical best practice. This is of particular importance given the high cost of the devices. Current clinical best practice for use of these item numbers includes:

-          All procedures being performed in the context of a comprehensive pain management approach with a multidisciplinary team.

-          Patients should be appropriately selected for the procedure, including, but not limited to assessment of physical and psychological function prior to implantation with findings documented in the medical record.

-          Outcome evaluation pre and post implantation.

-          Appropriate follow up and ongoing management of implanted medical devices should be ensured.

Implantable devices require ongoing monitoring and management. If the person providing the implantation service is not the ongoing physician manager of the device, they are responsible for ensuring that appropriate ongoing management has been arranged.

Items 39130 and 39139 provide for the insertion of one or multiple leads. There is no intention to change current billing practices for these items, e.g. where more than one lead is inserted as part of an episode then the item can be billed once per lead.

Item 39133 can be billed twice per attendance where services are separate procedures. Accompanying text is required for these claims such as one item is for the removal of an infusion pump and one item is for the removal or repositioning of a spinal catheter.

Related Items: 14218 39125 39126 39127 39128 39130 39131 39133 39134 39135 39136 39137 39139 39141

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Multiple Operation Rule

Spinal catheter, insertion or replacement of, and connection to a subcutaneous implanted infusion pump, for the management of chronic pain, including cancer pain (H)

(Anaes.) (Assist.)

Fee: $328.05 Benefit: 75% = $246.05

(See para TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

All of the following:
(a) infusion pump, subcutaneous implantation or replacement of;
(b) connection of the pump to a spinal catheter;
(c) filling of reservoir with a therapeutic agent or agents;
with or without programming the pump, for the management of chronic pain, including cancer pain (H) 

(Anaes.) (Assist.)

Fee: $398.30 Benefit: 75% = $298.75

(See para TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Subcutaneous reservoir and spinal catheter, insertion of, for the management of chronic pain, including cancer pain (H)

(Anaes.)

Fee: $521.40 Benefit: 75% = $391.05

(See para TN.8.4, TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

All of the following:
(a) infusion pump, subcutaneous implantation of;
(b) spinal catheter, insertion of;
(c) connection of pump to catheter;
(d) filling of reservoir with a therapeutic agent or agents;
with or without programming the pump, for the management of chronic pain, including cancer pain (H) 

(Anaes.) (Assist.)

Fee: $726.35 Benefit: 75% = $544.80

(See para TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Epidural lead or leads, percutaneous placement of, including intraoperative test stimulation, for the management of chronic neuropathic pain or pain from refractory angina pectoris (H)

(Anaes.) (Assist.)

Fee: $742.00 Benefit: 75% = $556.50

(See para TN.8.4, TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Epidural or peripheral nerve electrodes (management, adjustment, or reprogramming of neurostimulator), with a medical practitioner attending, for the management of chronic neuropathic pain or pain from refractory angina pectoris—each day

Fee: $140.70 Benefit: 75% = $105.55 85% = $119.60

(See para TN.8.244, TN.8.253 of explanatory notes to this Category)

Multiple Operation Rule

Either:
(a) subcutaneously implanted infusion pump, removal of; or
(b) spinal catheter, removal or repositioning of;
for the management of chronic pain, including cancer pain (H) 

(Anaes.)

Fee: $175.45 Benefit: 75% = $131.60

(See para TN.8.4, TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Neurostimulator or receiver, subcutaneous placement of, including placement and connection of extension wires to epidural or peripheral nerve electrodes, for the management of chronic neuropathic pain or pain from refractory angina pectoris (H) 

(Anaes.) (Assist.)

Fee: $374.85 Benefit: 75% = $281.15

(See para TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Neurostimulator or receiver that was inserted for the management of chronic neuropathic pain or pain from refractory angina pectoris, open surgical removal of, performed in the operating theatre of a hospital (H) 

(Anaes.) (Assist.)

Fee: $175.45 Benefit: 75% = $131.60

(See para TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Epidural or peripheral nerve lead that was implanted for the management of chronic neuropathic pain or pain from refractory angina pectoris, open surgical removal of, performed in the operating theatre of a hospital (H) 

(Anaes.) (Assist.)

Fee: $175.45 Benefit: 75% = $131.60

(See para TN.8.4, TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Epidural or peripheral nerve lead that was implanted for the management of chronic neuropathic pain or pain from refractory angina pectoris, open surgical repositioning of, to correct displacement or unsatisfactory positioning, including intraoperative test stimulation, other than a service to which item 39130, 39138 or 39139 applies (H) 

(Anaes.) (Assist.)

Fee: $666.35 Benefit: 75% = $499.80

(See para TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Epidural lead, surgical placement of one or more of by partial or total laminectomy, including intraoperative test stimulation, for the management of chronic neuropathic pain or pain from refractory angina pectoris (H) 

(Anaes.) (Assist.)

Fee: $996.25 Benefit: 75% = $747.20

(See para TN.8.244 of explanatory notes to this Category)

Multiple Operation Rule

Epidural or peripheral nerve electrodes (management, adjustment, or reprogramming of neurostimulator), with a medical practitioner attending remotely by video conference, for the management of chronic neuropathic pain or pain from refractory angina pectoris—each day

Fee: $140.70 Benefit: 75% = $105.55 85% = $119.60

(See para TN.8.244, TN.8.253 of explanatory notes to this Category)

Implanted infusion pump, refilling of reservoir with a therapeutic agent or agents for infusion to the subarachnoid space or accessing the side port to assess catheter patency, with or without pump reprogramming, for the management of chronic pain, including cancer pain

Fee: $107.85 Benefit: 75% = $80.90 85% = $91.70

(See para TN.8.244 of explanatory notes to this Category)