decisionhealth Newsletters, Answer Books - 2010 Issue 11 (November)
Transforaminal Epidural Injections / Stricter CPT definition threatens your payments
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Article Overview
This article reviews a coding and reimbursement change involving transforaminal epidural injections under CPT 2011 and its potential impact on payment. It is written for pain management and billing professionals who need to understand the updated definition, the related Medicare fee schedule context, and the practical contract and negotiation issues raised by the change.
Why This Topic Matters
The article matters because it highlights a service-definition change that may affect reimbursement, contract pricing, and payer negotiations for practices that perform transforaminal epidural injections. It also helps readers recognize the broader implications of imaging-related payment policy changes.
What You Will Learn
- How a CPT definition change can affect reimbursement for a procedure.
- Why payer contracts may need to be reviewed after a coding update.
- What general fee-setting and negotiation issues practices may want to consider.
- How Medicare fee schedule context can influence commercial payer discussions.
Who Should Read This
- Pain management physicians
- Medical coders
- Medical billers
- Practice managers
- Revenue cycle staff
- ASC administrators
Codes Discussed
Code Ranges Discussed
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