Reimbursement Resources

SI-BONE is pleased to offer the following reimbursement support for its iFuse-trained physicians:

  • iFuse Coding Guide
  • iFuse Reimbursement Guide
  • iFuse Reimbursement Support Services
  • iFuse Patient Appeal Guide
  • ISASS Statement on Coding Changes for Minimally Invasive SI Joint Fusion 2014
  • ISASS - Statement On Coding
  • SI BONE - Follow Up CPT Letter, September 2013
  • American Medical Association (AMA) - CPT® Assistant
  • Arnold & Porter, LLP memo
  • 2014 Hospital Setting Overview
  • State Insurance Commissioner Letter Template
  • iFuse Field Reimbursement Team

iFuse Coding Guide

The attached guide identifies the Category III CPT code that may be used to describe the iFuse sacroiliac joint fusion procedure. This code becomes effective for procedures performed on or after July 1, 2013. Category III CPT codes are temporary codes designated by the AMA to describe technologies or services that may be eligible for coverage and reimbursement by payors. Coverage and reimbursement is not guaranteed, and the use of such codes may require the submission of supporting documentation to support medical necessity.

iFuse Reimbursement Guide

The iFuse Implant System® represents the latest technology in treating sacroiliac joint disorders and, like other new technologies, is in the early stages of securing widespread coverage from payors. Physicians are strongly encouraged to contact their insurers to clarify coverage and coding guidelines specific to their patients based upon medical necessity. Non-Medicare payors may require prior authorization as with other surgical procedures.

iFuse Reimbursement Support Services

SI-BONE has partnered with The Pinnacle Health Group to offer reimbursement support services. Pinnacle provides direct support of coding, coverage and payment for physicians, health care providers and patients.

iFuse Patient Appeal Guide

This comprehensive guide provides a clear explanation of the insurance approval and appeals process. It also contains sample patient letters and state and federal advocacy resources for potential iFuse procedure candidates.

ISASS Statement of Coding Changes for Minimally Invasive SI Joint Fusion 2014

The ISASS (International Society for the Advancement of Spine Surgery) Statement discusses MIS SI joint fusion and can also be accessed directly on their website at: http://www.isass.org

International Society for the Advancement of Spine Surgery Proposed Recommendations for “Coverage Criteria” - Minimally Invasive Sacroiliac Joint Fusion

ISASS - Statement On Coding

ISASS - Statement On Coding Changes For Minimally Invasive SI Joint Fusion - July 2013

The ISASS (International Society for the Advancement of Spine Surgery) Statement discusses MIS SI joint fusion and can also be accessed directly on their website at: http://www.isass.org/public_policy/2013-08-07-isass-statement-minimally-invasive-si-joint-fusion-coding-changes.html

SI BONE - Follow Up CPT Letter, September 2013

Update on MIS SI joint surgery from SI-BONE's President & CEO.

American Medical Association (AMA) - CPT® Assistant

Official source for CPT coding Guidance September 2013 / Volume 23 Issue 9 Frequently Asked Questions

Arnold & Porter, LLP memo

Memo from outside legal counsel describing the potential CPT codes for MIS SI joint surgery.

2014 Hospital Setting Overview

2014 CMS coding and reimbursement data.

State Insurance Commissioner Letter

Materials to use when contacting State Insurance Commissioners and/or State Medical Societies when discussing access to the iFuse procedure.

National Association of Insurance Commissioners

List of Insurance Commissioners by state.

 
 

iFuse Field Reimbursement Team

SI-BONE has a fully-staffed, field-based team available to support your iFuse reimbursement needs. To speak with or schedule a visit with your regional reimbursement manager please call 408-207-0700 or email: info@si-bone.com.

DISCLAIMER:  The iFuse Implant System is intended for sacroiliac joint fusion for conditions including sacroiliac joint disruptions and degenerative sacroiliitis. As with all surgical procedures and permanent implants, there are risks and considerations associated with surgery and use of the iFuse Implant. Please review the iFuse Instructions For Use for a complete discussion of contraindications, warnings, precautions, and risks.This document is for informational purposes only and is not legal advice or official guidance from payors. It is not intended to increase or maximize reimbursement by any payor. Hospitals and physicians are solely responsible for being in compliance with Medicare and other payer rules and requirements and for the information submitted with all claims and appeals. SI-BONE does not warrant or guarantee that the use of this information will result in coverage or payment for SI joint fusion. Before any claims or appeals are submitted, hospitals and physicians should review official payor instructions and requirements, should confirm the accuracy of their coding or billing practices with these payors and should use independent judgment when selecting codes that most appropriately describe the services or supplies provided to a patient. CPT five-digit numeric codes, descriptions, and numeric modifiers only are Copyright AMA. All rights reserved.

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Reimbursement

The information appearing on this site was gathered from third party sources and is subject to change without notice.  SI-BONE has compiled the information for convenience only.  It is not legal advice nor official payor guidance.  SI-BONE does not warrant or guarantee that the use of the information will result in coverage or payment.  Providers are solely responsible for determining medical necessity and for being in compliance with Medicare and other payor rules and requirements, as well as for the information they submit with claims and appeals.  Before any claims or appeals are submitted, providers should review official payor instructions and requirements, confirm the accuracy of their coding or billing practices with these payors, and use independent judgment when selecting codes that most appropriately describe the services or supplies provided to a patient.

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