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Guidepoint Reimbursement
GuidePoint is Boston Scientific’s suite of health economic and reimbursement resources for hospitals, physicians, clinicians, and reimbursement professionals seeking a better understanding of reimbursement for Boston Scientific products and procedures.
Coding, 2010 Procedural Reimbursement Guide
This Procedural Reimbursement Guide for select Percutaneous Cardiovascular and other interventional procedures – Coronary and Peripheral - provides coding and reimbursement information for physicians and facilities.
Coding, Interventional Cardiology C-code Cross-Reference Guide
This C-code cross reference guide crosswalks Boston Scientific interventional cardiology products by product numbers to Medicare hospital outpatient category codes (C-codes).
Coding, 2010 IVUS Coronary
This guide provides reimbursement information on coronary intravascular ultrasound (IVUS) procedures.
Coding, 2010 Carotid Artery Stenting (CAS) Quick Reference
This guide provides coverage, coding and reimbursement information for carotid artery stenting procedures that utilize Boston Scientific products.
CMS Payment, 2010 Medicare Final HOPPS, ASC and Physician Payment Rates
Medicare final rules (FR) highlights for two documents published October 30, 2009. The first FR addresses the payment and policies for hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASC). The second Final Rule addresses physician payment and policy. Final payment rates are to be effective January 1, 2010.
Coverage, Initial App and Recertification for Eligibility for Medicare Reimbursement for CAS
This document reviews the processes and data submission requirements and timelines for seeking Medicare certification and recertification as a CAS facility. Also includes list of eligible facilities.
Coverage, Template Initial Certification Letter for Facilities with Prior Clinical Trial Experience
If your facility has CAS clinical trial experience and you would like to request inclusion on the list of facilities eligible for Medicare reimbursements for CAS procedures, please refer to this template for sample guidelines.
Coverage, Template Initial Certification Letter for Facilities with No Clinical Trial Experience
If your facility does not have CAS clinical trial experience, but meets the minimum standards for facilities eligible for reimbursement for CAS procedures, as outlined in the CMS National Coverage Determination (NCD) for Percutaneous Transluminal Angioplasty (PTS) and CAS, and you would like to request inclusion on the list of Medicare-approved, please refer to this template for sample guidelines.
Coverage, Template Letter for Prior Approval/Medical Necessity
The following is a sample letter template that can be used for guidance by physicians when submitting claims to Medicare and when seeking prior authorization or submitting claims to non-Medicare payers.
Non-Medicare Coverage for Carotid Artery Stenting (CAS)
Reference document with summary of non-Medicare coverage for carotid artery stenting. The Document was created in November 2009 with then-current coverage information found on the selected non-Medicare payer’s medical policy webpages. Please Note: This information is accurate as of the date of print and is provided as a reference, and may change frequently and without notice. This information assumes, in each instance, that the procedure is medically necessary and otherwise appropriate for reimbursement and that all necessary documentation will be made available to the provider. Physicians may not rely on the compiled information as a promise or guaranty of coverage and Boston Scientific strongly suggests that facilities and physicians always confirm coverage status and all applicable requirements and restrictions with specific payers prior to performing CAS procedures.
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