Reimbursement support

The Patient Advocacy Program (PAP) looks forward to working with you to provide reimbursement support. PAP can be contacted at:

Phone: 888-325-9772 | Fax: 303-474-3139

Email: reimbursement@barricaid.com

Commonly billed codes

It is the provider’s responsibility to select the most specific codes to report a patient’s condition and services rendered. The following may provide applicable coding information for the Barricaid treatment. Some payors may have unique coding requirements; please verify coding with the health plan.

Diagnosis coding

Barricaid is indicated for reducing the incidence of reherniation and reoperation in skeletally mature patients with radiculopathy (with or without back pain) attributed to a posterior or posterolateral herniation. Confirmation for treatment should be established by history, physical examination and imaging studies which demonstrate neural compression using MRI to treat a large annular defect (between 4-6mm tall and between 6-10mm wide) following a discectomy procedure (excision of herniated intervertebral disc) at a single level between L4 and S1. Listed are the most commonly billed ICD-10 diagnosis codes which may be appropriate based on the patient’s condition(s) and history.

For full instructions for use, please click here.

ICD-10-CMDescription
M51.06Intervertebral disc disorders with myelopathy, lumbar region
M51.16Intervertebral disc disorders with radiculopathy, lumbar region
M51.17Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.26Other intervertebral disc displacement, lumbar region
M51.27Other intervertebral disc displacement, lumbosacral region
M51.36Other intervertebral disc degeneration, lumbar region
M51.37Other intervertebral disc degeneration, lumbosacral region
M54.30Sciatica, unspecified side
M54.32Sciatica, left side

Physician coding & Medicare payment information

Physician Services Hospital/ASC
63030Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, single interspace; lumbar.$1014.48
or
63042Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar.$1354.80
22899Unlisted procedure, spineLocal MAC Priced

Click here for Commonly Billed Codes – PDF

Facility Hospital Outpatient or Ambulatory Surgery Center (ASC) -National Average Payment

Hospital Outpatient

CPT/HCPCSDescriptionAPC - Hospital OutpatientAPC PaymentSI
C9757Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone-anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1interspace; lumbar.5115$11,900.71J1
C1713Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)UnassignedUnassignedN

Ambulatory Surgical Center (ASC)

CPT/HCPCSDescriptionASC PaymentPI
C9757Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone-anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1interspace; lumbar. $7,465.38J8
C1713Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)Not Utilized in ASC--

Hospital Outpatient or Ambulatory Surgery Center (ASC) Commercial

CPT/HCPCSDescriptionOutpatient Hospital PaymentASC Payment
C9757Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone-anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1interspace; lumbar.Payor PricedPayor Priced

Disclaimer: Healthcare providers are solely responsible for reporting the codes that accurately describe the services provided to a particular patient as well as the patient’s medical condition or diagnosis. Providers should follow payor-specific billing and coding requirements and contact the payor if they have questions. Note that the existence of a code for a procedure does not guarantee coverage or payment. This guide includes Medicare national average payment rates rounded to the nearest dollar. Payment rates to individual providers will vary based on geographic location and other provider-specific factors, including participation in various quality programs. The information included herein is shared for educational purposes only and does not constitute legal advice. The information is based upon publicly available information. Providers are reminded that reimbursement is dynamic. Codes, coverage, and payment rates change, at minimum, on an annual basis, and may be changed periodically throughout the year. The information is current as of February 10, 2020.

Prior authorization

Medicare

Prior authorization is not required for Medicare patients receiving their benefits through the original Medicare system.

Commercial health plans & Medicare Advantage

Prior authorization for Barricaid is usually required by commercial health plans and Medicare Advantage plans.

To assist you in the prior authorization process, Intrinsic Therapeutics, Inc. provides a prior authorization team to assist you with Barricaid cases.

Prior authorization denials

For additional guidance contact the Patient Advocacy Program at 888-325-9772, or by email at reimbursement@barricaid.com.

Frequently asked questions

Medicare

Please refer to the Commonly Billed Codes section of this website, or the Commonly Billed Codes PDF for national unadjusted Medicare Hospital Outpatient and Ambulatory Surgery Center payment levels. Please verify your specific payment levels with your local Medicare carrier.

Non-Medicare

It will be at the discretion of the individual health plan whether they will require CPT codes or HCPCS codes for hospital outpatient or Ambulatory Surgery Center Barricaid claims. Please verify appropriate coding with the health plan. Non-Medicare reimbursement levels may be calculated based on a percentage of the Medicare hospital outpatient fee schedule, ASC fee schedule or negotiated contracts.

Health insurance coverage and payment

Who covers the Barricaid Annular Closure Device (ACD) and associated surgery?

A number of health plans may cover Barricaid when medical necessity has been established. For information regarding a specific insurance company, please contact the patient’s insurance plan or the Patient Advocacy Program (PAP) at 888-325-9772.

What is unique about prior authorization for the Barricaid procedure?

a. The Barricaid procedure has an assigned HCPCS code that is reported for hospital/ASC billing and an unlisted CPT code is reported for physician billing.  The codes submitted for authorization may vary based on site of service. When submitting for a prior authorization, you may have to prior authorize both the CPT code for physician services and the HCPCS code for facility billing.
b. The PAP can assist the physician’s office staff to determine the payor approval process for submitting prior authorization requests and will submit on the behalf of the patient if the patient is participating in the PAP.

How is Barricaid typically coded?

A:  Coding varies based on provider, site of service and payor requirements. For example, the physician may report:
a.         CPT 63030- Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar OR
b.         CPT 63042 – Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar AND
c.         CPT 22899 – Unlisted procedure, spine
The hospital outpatient department will report:
•           C9757 – Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar; and
•           C1713 – Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable). (The ASC will report only C9757.)
For complete coding descriptions see the Barricaid Commonly Billed Codes PDF at www.barricaid.com.

Who is a candidate for Barricaid?

The physician will determine if the patient is a candidate for the Barricaid, which is indicated for patients who have a large annular defect, i.e. 4-6mm in height and 6-10mm in width, at a single level between L4 and S1.

Is the Barricaid permanent or can it be removed?

The implant is intended to be permanent. However, the implant can be removed if needed.

What is the cost of the Barricaid?

Please contact your Barricaid Sales Representative for pricing information.

What should I do if I get a prior authorization or claim denial?

It is important to appeal prior authorizations and claim denials.  If there are questions regarding appealing prior authorizations or claims, please contact the relevant payor or the Barricaid PAP at 888-325-9772.

Where can I find medical necessity data for the Barricaid ACD?

We recommend that you confirm medical criteria with the specific health plan as requirements may vary.

What examinations are needed prior to implanting the Barricaid?

The physician must decide the appropriate examinations to conduct based on his or her clinical experience.  The FDA does have certain indications including that the patient be skeletally mature with radiculopathy (with or without back pain) attributed to a posterior or posterolateral herniation, and confirmed by history, physical examination and imaging studies which demonstrate neural compression using MRI.  In addition to these requirements, the patient’s health plan may require additional diagnostic examination(s).

Will the device interfere with having an MRI?

A: The Barricaid device is MR conditional. A patient with this device can be scanned safely in an MR system immediately after placement under the following conditions:
•           Static magnetic field of 1.5-Tesla and 3-Tesla, only
•           Maximum spatial gradient magnetic field of 3000 Gauss/cm or less
•           Maximum MR system reported, whole body averaged specific absorption rate (SAR) of 2-W/kg for 15 minutes of scanning in the Normal Operating Mode of operation for the MR system
Under the scan conditions defined, the Barricaid is expected to produce a maximum temperature rise of 1.6˚C after 15 minutes of continuous scanning.

Is fluoroscopy included in the Barricaid implant procedure?

The Barricaid implantation procedure is performed using fluoroscopic guidance.

Contact information

Phone: (888) 325-9772

Fax: (303) 474-3139

If Barricaid is right for you, we can help.

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