Stretta: CPT code doesn't guarantee payment by privates or Medicare

Why This Topic Matters

New procedure codes do not always mean automatic reimbursement. Understanding payer-specific coverage policies and beneficiary notice requirements helps providers reduce denials and manage patient liability appropriately.

Article Sections

1. Coding and payment status for Stretta

   This section discusses the introduction of a new procedure code and the related Medicare payment status and pricing context.

2. Private payer coverage considerations

   This section addresses how commercial payers may respond differently from Medicare to the same service and coding update.

3. Advance Beneficiary Notice guidance

   This section summarizes general ABN considerations and beneficiary liability concepts for services that may not be covered.