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Positive Reimbursement Picture for Cysview® (hexaminolevulinate HCl) is Helping Drive Use in 2019

More and more bladder cancer patients are gaining access to Blue Light Cystoscopy (BLC™) with Cysview for detection and surveillance. This growing trend is because of increasing awareness and availability of this cutting-edge drug-device procedure, plus an improved reimbursement picture in 2019.

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
Positive reimbursement picture for Cysview outpatient

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
Outpatient_Centers_Positive_Reimbursement_for_Cysview.png

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
    • Add in A9589 for Cysview
    • Private payers tend to pay separately for Cysview. 
Medicare_Positive_Reimbursement_for_Cysview.png

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
Clinic_Positive_Reimbursement_for_Cysview.png

For more information about Blue Light Cystoscopy with Cysview, visit Cysview.com or call 1-855-CYSVIEW.

 

References:
  1. 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
  2. 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