If I used radiofrequency to treat a patient and billed CPT 64624, can I re-treat the patient using CPT 64624 for an iovera° treatment? If so, is there a limit to doing this in the same year?
The Medicare guidelines do not definitively state whether there is a limit on how many times a year you can bill CPT 64624. The procedure needs to be supported by medical necessity, including comprehensive clinical documentation with specific nerves being treated and the diagnosis code. Please be aware, this documentation does not guarantee reimbursement. We recommend that you contact our Reimbursement Helpline to review the situation prior to performing the treatment.
If a doctor performs iovera° treatment on the same day that an orthopedic surgeon performs total knee arthroplasty (TKA) in the HOPD or ASC, does it prevent the facility from capturing the facility fee for the CPT codes applied to the iovera° treatments and the TKA? Is this impacted by the diagnosis code?
Unless there is a contract that includes bundling of procedures, the facility fee would apply to the CPT codes for the iovera° treatments and the TKA CPT code. The ICD-10-CM diagnosis code does not affect whether a CPT is captured in an outpatient setting.
It’s important to be aware that the global period for CPT 64640 and 64624 is 10 days. This may impact the TKA reimbursement if the iovera° treatments and TKA are performed on the same day.
Please contact our Reimbursement Helpline to review the specific situation for appropriate guidance and support.
When treating the 3 nerves for AFCN and ISN as well as the deep genicular nerves, what would be the total relative value units (RVUs)?
If the documentation indicates that the AFCN and ISN are being treated, this would be considered 2 separate nerves. If the deep genicular nerves are being treated, it would be considered 1 nerve.
The total RVUs would be based on the RVUs specific to the work component:
Based on the 3 nerves treated, the work RVUs would be 6.46 work RVUs. It’s also possible that you may have contracts with hospitals that may have different RVUs assigned than the Medicare RVUs. Please see the Coding and Medication Guide for more information.
Can iovera° be performed on the same day as a TKA procedure, and would my practice be reimbursed for both the iovera° treatments and the TKA procedure?
Although cryoneurolysis CPT codes applicable for iovera° treatments are not bundled into the TKA code by Medicare, there is no guarantee of reimbursement for both procedures on the same date of service.
The global period for CPT 64640 and CPT 64624 is 10 days, which is counted as day 1 for the date of service (DOS) plus 10 days, for a total period of 11 days. This should be the time frame between the iovera° treatment(s) and the TKA. We would not definitively advise you that both procedures cannot be performed on the same date of service, but doing so may result in a denial for either the iovera° treatment(s) or the TKA. Modifiers may also be needed to bill these procedures on the same day. Commercial payer policies vary.
We recommend that you contact our Reimbursement Helpline in advance to further discuss the situation and obtain guidance.
Can both the superficial and deep genicular nerves be treated during the same session? If yes, how would the procedures be billed and reimbursed?
Yes, superficial genicular nerves and deep genicular nerves can be treated in 1 session. As noted in the iovera° Coding and Reimbursement Guide, use CPT 64640 for the superficial nerves treated and CPT 64624 for deep genicular nerves (superolateral, superomedial, and inferomedial).
Modifier 51 may be required, and some commercial payers may require Modifier 59. 64624 should be listed first since it has the highest RVU. Billing both 64624 and 64640 will result in applying multiple procedure billing rules depending on the number of nerves treated using CPT 64640.
Our dedicated reimbursement specialists at the Reimbursement Helpline are happy to provide additional support and assistance.