As we know Medicare payment or the lack there of for CT Perfusion (0042T) is challenging particularly when the patient presents with stroke symptoms and is negative for stroke on imaging.
I have worked with each Medicare MAC for many years to petition for change in policy to include ICD-10 codes for stroke symptoms. In 2022 Noridian agreed to include 4 signs and symptoms in their policy. In 2022 the reconsideration petition to include signs and symptoms was deemed valid for Palmetto GBA, representing states including Alabama, Georgia, Tennessee, North Carolina, South Carolina, Virginia, and West Virginia.
We are almost there. Palmetto released their draft policy in December to include the addition of 53 ICD-10 codes representing signs and symptoms, Draft DA58354.
Note – It generally takes about 45 days once the comment period is over. The comment period for this proposed policy ended 2/17/2024. We are simply waiting for Palmetto GBA to assign an effective date, however, the MAC does have the discretion to extend the notice period. We will wait and see.
Once the effective date is assigned…..on to the remaining Medicare MACs.
This is a win for both the radiologists and the patients.
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Kim Snyder CPC
Kim Snyder LLC
Cell 706-577-8751
kimd.snyder@outlook.com------------------------------