Blogs

Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Arkansas reviewed its Sacral Nerve Stimulation for the Treatment of Urge Urinary Incontinence Policy, and BCBS Massachusetts reviewed its Focal Treatments for Prostate Cancer Policy. Additionally, Aetna reviewed its Ablative Procedures for Prostate ...
0 comments
Q: We were approached by a company offering a home uroflow device for patients, and telling us that if the patient sends us the results then we can charge for the uroflow and also for remote patient monitoring. Is this true? This is an excellent question. Recently there have been a number of companies that have ways of measuring a uroflow from the patient’s home, either using a home device or a smartphone app. We do believe we will be seeing more of these types of devices in the future, especially as we proceed further into telemedicine. When looking into what codes a provider may use to bill these services, on the surface some codes may seem to fit. ...
0 comments
Stimulation of the posterior tbial nerve has been used in treatment of patients with overactive bladder symptoms. Currently, there is one Category I CPT code that can be used to report a single stimulation treatment with a needle electrode: 64566 Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming This code is used to report a treatment session where a small needle is placed percutaneously next to the posterior tibial nerve with subsequent stimulation of the nerve, typically for 30 minutes, with removal of the needle immediately after stimulation. Typically patients are scheduled for a series of treatments, ...
0 comments
On June 30, the Senate passed legislation that would extend the deadline for businesses to apply for the Paycheck Protection Program (PPP) to August 8. On July 1, the House of Representatives unanimously passed the application deadline legislation, and President Trump is expected to sign the measure into law. The application deadline was June 30, 2020, but the program still has roughly $130 billion of unused funds remaining. The additional five weeks should give small businesses more opportunity to participate in the program without disruptions while the House and Senate negotiate the next COVID relief package – which is expected to come out of the Senate ...
0 comments
On June 18, the AUA, along with 53 other medical organizations, signed on to a letter requesting that Congress waive budget neutrality requirements for the finalized evaluation and management (E/M) code proposal slated for implementation by the Centers for Medicare & Medicaid Services (CMS) on January 1, 2021. The AUA has signed onto the several letters requesting budget neutrality; we are not alone in our concern that the financial instability created by the COVID-19 public health emergency will be exacerbated by the budget neutrality adjustments required by the 2021 E/M changes. In the 2020 Medicare Physician Fee Schedule (PFS) final rule published in ...
0 comments
The COVID-19 pandemic has greatly impacted the 2020 reporting period for clinicians. The Centers for Medicare & Medicaid Services (CMS) recently announced relief for clinicians and groups participating in the 2020 Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS). Clinicians and groups affected by extreme and uncontrollable circumstances may submit an Extreme and Uncontrollable Circumstances Exception Application to re-weight any or all MIPS performance categories. The circumstances are defined as rare events outside of a clinician’s control and the control of the practicing facility. Such circumstances would: Cause a clinician ...
0 comments
As required by law, the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency established to advise Congress on issues affecting the Medicare program, released its June 2020 Report to Congress. The Commission addressed multiple topics in the report, including: change toward value-based payments (VBP) in Medicare, strategies to increase savings in accountable care organizations (ACOs), replacing the Medicare Advantage quality bonus program, and the impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees. MedPAC’s recommendations to Congress focus on improving quality and payment in Medicare ...
0 comments
On July 1, 2020 two new Category III CPT codes will be available describing the placement or removal/replacement of the inFlow ™ Intraurethral Valve-Pump device: CPT 0595T , Temporary female intraurethral valve-pump (i.e., voiding prosthesis); initial insertion, including urethral measurement CPT 0596T , Temporary female intraurethral valve-pump (i.e., voiding prosthesis);  replacement Background: The inFlow™ Intraurethral Valve-Pump is a non-surgical replaceable urinary prosthesis for women with permanent urinary retention due to impaired detrusor contractility (IDC). The device sits across the urethra and can actively expel urine when activated ...
0 comments
The Centers for Medicare & Medicaid Services (CMS) officially opened the Physician Compare 60-day Preview Period, which runs from June 22-August 20, 2020 at 8 p.m. EDT. During this period, clinicians and groups will have the opportunity to preview their 2018 Quality Payment Program (QPP) performance information before it is published publicly on the Physician Compare website and in the Physician Compare Downloadable Database. The Physician Compare Downloadable Database provides the most current available data for Physician Compare and additional technical information that may be useful to researchers and other interested individuals. The Database is ...
0 comments
Engagement with lawmakers is more important than ever before, particularly as Congress moves forward on legislation related to the COVID-19 pandemic that will directly impact the health care community. It's never been easier to get involved – make plans now to join the AUA in August when we bring Washington, DC, to you with the Virtual Annual Urology Advocacy Summit!  Evening programming will begin on August 31. The Summit will also feature a virtual Hill Day of meetings with lawmakers and Congressional staff that will take place on September 1.  Featured speakers include: COVID-19 will, no doubt, have a lasting impact on ...
0 comments
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Alabama reviewed its Myobloc Policy and BCBS North Carolina reviewed its Prostatic Urethral Lift Policy. Additionally, First Coast Service Options released its Transurethral Waterjet Ablation of the Prostate Draft Local Coverage Determination ...
0 comments
The AUA, along with many other partners in the medical community, has been actively engaged in advocacy to extend the COVID-19 Public Health Emergency (PHE) – and the policies that have allowed providers to continue providing patients with uninterrupted access to health care services. The AUA submitted a letter to HHS on June 26 requesting that the PHE – due to expire July 25 – be extended. Other organizations submitted requests for the extension.   On June 29, Department of Health and Human Services (HHS) spokesperson Michael Caputo shared via social media that HHS intends to extend the COVID-19 public health emergency (PHE) by an additional 90 days. This ...
0 comments
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Alabama reviewed its Botox and Irreversible Electroporation (IRE) policies. Additionally, CGS Administrators retired its Aldesleukin, Proleukin, and Interleukin II and Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer Local ...
0 comments
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Aetna reviewed its Benign Prostatic Hyperplasia (BPH) and Tumor Markers Policies, and Blue Cross Blue Shield (BCBS) Louisiana reviewed its Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies Policy. Additionally, CGS Administrators released its draft ...
0 comments
On June 17, the Senate Health, Education, Labor and Pensions (HELP) Committee will hold a hearing to examine telehealth lessons learned from the COVID-19 pandemic. This hearing is a critical early step in educating lawmakers and ensuring physicians can continue to maximize the benefits of telehealth and enhance patient access to care after the COVID-19 public health emergency ends. Those testifying at the hearing are Dr. Joseph C. Kvedar, President of the American Telemedicine Association; Dr. Andrea Willis, Chief Medical Officer of BlueCross BlueShield of Tennessee; Dr. Karen S. Rheuban, Director of the University of Virginia’s Karen S. Rheuban Center for ...
0 comments
This spring, Connecticut urologist Dr. Arthur Tarantino became the chair of the AUA’s State Advocacy Committee. A long-time advocate for the specialty of urology both in his home state and at the national level, Dr. Tarantino succeeded Dr. Bill Gee, who chaired the committee since its first meeting in 2018. We spoke with Dr. Tarantino about what first drew him to advocacy, active issues at the state level, and what AUA members can do to get involved and advance change. Q: How did you get started in state advocacy? A: I was born and raised in Washington, DC, when it was a small city and at a time when vice presidents lived in their own homes. Politics ...
0 comments
Lawmakers remain at odds about when the fourth coronavirus relief package should be taken up, and what provisions the bill should contain. Senate Republican Leadership is opposed to extending enhanced unemployment benefits, which is a major proposal contained in the $3 trillion House-passed measure (HEROES Act) that the GOP rejected several weeks ago. While the administration has acknowledged that more stimulus legislation will likely be necessary, Republicans have indicated that they are not in a hurry to pass more relief and instead are in favor of assessing the impact of previously passed stimulus packages before considering additional legislation. They also ...
0 comments
Medical liability reform is one of the AUA’s advocacy priorities and we work with multiple organizations to support and advance legislation to address this key concern. Recently, Reps. Phil Roe, MD (R-TN-01) and Luis Correa (D-CA-46) introduced legislation that would provide health care professionals, and the facilities in which they work, protections from COVID-19-related lawsuits. The Coronavirus Provider Protection Act ( H.R. 7059 ) would provide liability protections when:   The act or omission occurred during the declared COVID-19 public health emergency or within 60 days of termination of the emergency; The act or omission occurred while providing ...
0 comments
The top takeaway was a focus on the prior authorization for certain hospital outpatient department (OPD) services process. PA for Certain Hospital OPD Services Through the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (CMS-1717-FC), CMS established a nationwide prior authorization process and requirements for certain hospital OPD services. This process serves as a method for controlling unnecessary increases in the volume of these services. This only effects services performed in the hospital outpatient department. The PA is not required in ambulatory surgical centers (ASCs), provider offices, etc. The following ...
0 comments
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. Due to the volume of insurance policy updates, we are focusing our updates on the Medicare Administrative Contractors (MACs) and the major commercial insurance companies. This week’s update includes the release of COVID-19 and telehealth/telemedicine specific newsletters and policy updates. Blue Cross Blue Shield (BCBS) Rhode Island released its draft Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer Policy, and Horizon BCBS New Jersey reviewed its Intravesical Transurethral Electric Bladder Stimulation (ITEBS) Policy ...
0 comments