Reimbursements

Goals

Determine the case count, reimbursement per case, and reimbursement code for Pain Therapy Spine (CT guided), Needle Biopsies, RF Ablation, Cryoablation, Laser induced thermotherapy, microwave ablation, irreversible electroporation, vertebroplasty, prostate biopsies, PCNL, and Brachytherapy in order to understand the market size for a new CT guided navigation product.

Early Findings

Laser Induced Thermotherapy: United States

  • We attempted to find the total number of Laser Induced Termotherapy treatments in the US annually, however, this could not be determined.
  • It appears that this procedure is not covered in the US by most private insurance as there is "insufficient evidence of its clinical effectiveness."
  • However, the procedure may be covered by Medicare (via a new technology add on payment), however, findings were conflicting and no reimbursement rate could be determined.
  • It was determined that Brain LITT to treat high grade gliomas has an average cost of $89,839 per procedure.
  • Reimbursement codes utilized seem to follow the format "Unlisted procedure, [location of therapy]". Possible codes include: 19499 - Unlisted procedure, breast; 32999 - Unlisted procedure, lungs and pleura ; 53899 - Unlisted procedure, urinary system; 55899 - Unlisted procedure, male genital system ; 64999- Unlisted procedure, nervous system.

Proposed next steps:

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As the initial research showed that determining the case count, reimbursement per case, and reimbursement code for Pain Therapy Spine (CT guided), Needle Biopsies, RF Ablation, Cryoablation, Laser induced thermotherapy, microwave ablation, irreversible electroporation, vertebroplasty, prostate biopsies, PCNL, and Brachytherapy in multiple regions would most likely result in insufficient and conflicting findings, we recommend focusing the research on the general insurance reimbursement landscape for CT (computed tomography) guided navigation in each of the following regions: EU, US, Germany, India, China, Japan.
Alternatively, we could attempt to dig in further and determine the case count, reimbursement per case, and reimbursement code for each of the seven procedures (Pain Therapy Spine (CT guided), Needle Biopsies, RF Ablation, Cryoablation, Laser induced thermotherapy, microwave ablation, irreversible electroporation, vertebroplasty, prostate biopsies, PCNL, and Brachytherapy) in one country (US, Germany, India, China, Japan). Preliminary research indicates that only limited data points may be found, however. Additionally, EU and global datasets will not be able to be determined as each country has their own unique health system. We could start with one country and continue the project to other countries after the results have been reviewed.