tci Part B Insider - 2006 Issue 6

OPTHOPEDICS: Alert--Now's The Time To Fight For ESWT Coverage

Two carriers already say they won't cover new code 28890 Coders rejoiced when CPT 2006 introduced a new code for extracorporeal shock wave therapy (ESWT): 28890. At last, you no longer have to use an unlisted code or the temporary code 0020T. But once again, the carriers have proved that just because something has a code doesn’t mean Medicare will pay for it. Two carriers, Trailblazer Health Enterprises and HGSAdministrators, both put out local coverage decisions stating that ESWT is an “experimental” treatment and therefore non-covered. So far, only one carrier says it’s willing to pay...

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