Both private payers and Medicare reimburse for the cystoscopy procedure and the optical imaging agent that makes non-muscle invasive bladder cancer glow bright pink under blue light.
For detailed information about Cysview reimbursement, download the 2019 Commercial Payer and Medicare Reimbursement Guides.
Here is a summary overview of what you can expect.
In the Hospital Inpatient Setting (OR)
- Add in Code A9589 for Cysview and the cost.
- Medicare pays a lump sum per admission.
- Many private payers use DRGs.
- Other private payers pay per-diems, case rates, or percent of charges.
- On average, private payers reimburse at 150%-175% of Medicare rates for inpatient services.1
For Hospital Outpatient Procedures
- Medicare
- Add in C9738 for Blue Light Cystoscopy adjustment code.
- ALSO add in A9589 for Cysview.
- Medicare pays a single rate according to Ambulatory Payment Classifications (APCs).
- Private Payers:
- Add in A9589 for Cysview.
- There are specific codes specifically for the BLC procedure that result in incremental reimbursement.
- Private payers use a variety of mechanisms to pay for outpatient costs.
- On average, private payers reimburse up to 150% of Medicare rates for outpatient services.1
For Ambulatory Surgical Centers
- Medicare
- Add in A9589 for Cysview
- Medicare pays based on a percentage of the associated hospital’s outpatient APC rate.
- Private Payers
In Office/Clinic Setting
- Medicare
- Add in A9589 for Cysview.
- Medicare uses an office-based (aka Non-Facility Based) differential for some procedure codes that are designed to compensate for the higher practice expense of office-based services.
- Private Payers
- Add in A9589 for Cysview.
- On average, private payers reimburse at 100%-150% of Medicare rates for physician specialist services.2
For more information about Blue Light Cystoscopy with Cysview, visit Cysview.com or call 1-855-CYSVIEW.
References:
- White, C, et al. High and Varying Prices for Privately Insured Patients Underscore Hospital Market Power. Center for Studying Health System Change. Research Brief no. 27. September 2013
- Selden T, et al. The Growing Difference between Public and Private Payment Rates for Inpatient Hospital Care. Health Affairs 34, NO. 12 (2015): 2147-2150