Are there special rules for pricing implantable devices?
A65. Yes. Effective October 1, 2008 if the Medicare Set-aside proposal includes the pricing for any implantable device(s) and does not include enough information or if it is determined upon review that the Medicare Set-aside proposal that an implantable device is recommended for the injured worker but has not been included in the Medicare Set-aside proposal, CMS will utilize its own pricing methodology. If an implantable device is being used or recommended you should consult with the appropriate physician and include the following information in the Medicare Set-aside pricing:a. Device, electrodes, receiver manufacturer nameb. Device, electrodes, receiver model # or typec. Device, electrodes, receiver cost including tax, freight and handlingd. Facility fee, whether inpatient or outpatient, procedure code and coste. Surgeon procedure code and costf. Anesthesiologist procedure code and costh. Programming services procedure code, frequency and costi. Other associated costs Prescription Dr
