Reimbursement
We can help you maximize your reimbursement in both fee-for-service and managed care environments.
- Fee-For-Service (CPT Codes)
- Managed Care (HCC Codes)
Fee For Service (CPT Codes)
Noninvasive Vascular Testing to diagnose Peripheral Artery Disease is reimbursable using CPT codes 93922 and 93923. Sudomotor testing to diagnose Peripheral Autonomic Neuropathy is reimbursable using CPT code 95923.
Schedule a quick chat with a Smart-ABI team member today for more information about CPT reimbursement in your area.
Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries (e.g. for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurement at 1-2 levels)
Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (e.g., for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (e.g., measurements with provocative postural tests, or measurements with reactive hyperemia)
Sudomotor function testing – Used to evaluate and document neuropathic disturbances that may be associated with pain. The quantitative sudomotor axon reflex test (QSART), thermoregulatory sweat test (TST), sympathetic skin responses, and silastic sweat imprints are tests of sympathetic cholinergic sudomotor function.
Managed Care (HCC codes)
Using HCC 108, a managed care provider that diagnoses a patient with PAD is eligible for approximately a $238/month RAF increase.
Using HCC 18, a managed care provider that diagnoses a patient with diabetes with a chronic condition such as PAD or PN is eligible for approximately a $171/month RAF increase.
Schedule a quick chat with a Smart-ABI team member to discuss how our solution can maximize diagnosis in your patient population.
Don’t take our word for it! Click the link below to view a webinar by nationally recognized Dr. Jeffrey Lehrman DPM, FASPS, MAPWCA, CPC discussing the patient selection criteria for arterial studies as well as the coding, compliance, and documentation needed to bill for these studies in your office.
Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2019 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). CPT codes and their descriptions do not reflect or guarantee coverage or payment. Just because a CPT code exists, payment for the service it describes is not guaranteed. Coverage and payment policies of governmental and private payers vary from time to time and for different areas of the country. Questions regarding coverage and payment by a payer should be directed to that payer. Hyperion Medical Technologies, Inc. does not claim responsibility for any consequences or liability attributable to the use of any information, guidance, or advice contained on this website.