Reimbursement

  • Jim, team lead for Coding and Reimbursement, talks to a clinical division leader about a presentation the team is preparing for an upcoming sales meeting.

    Jim, team lead for Coding and Reimbursement, talks to a clinical division leader about a presentation the team is preparing for an upcoming sales meeting.

Get Help When You Need It

If you are not sure how to code for a procedure in which a Cook Medical device is used, we have a team that may be able to help.

Quick Tools Quick Tools

Reimbursement C-Code Finder

Find the right C-code for one of our products.

To find the C-code for a product, please enter the product’s order number.
(Ex: G48403).

Reimbursement C-Code Finder

TFFB-22-82-ZT

Reimbursement C-Code Finder

Could not find a product order number.

Medicare Updates

Medicare has made some significant changes to its Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center (ASC) payment system, and Physician Fee Schedule (PFS) for 2015. In the memos below, we have identified some of the most significant changes. We chose to focus only on changes of greater than or equal to $100 for the OPPS, ASC, and PFS from 2014 to 2015.

How Can We Help?

Our reimbursement assistance team can provide:

  • Medicare reimbursement rates
  • Assessment of Medicare and commercial insurance coverage policies
  • Coverage appeals support

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Coding and Reimbursement Guides Coding and Reimbursement Guides

*Cook’s policy is to offer only information that is complete, accurate, straightforward, and consistent with the statutes and regulations of the federal government and well-accepted coding guidelines as established by the Centers for Medicare and Medicaid Services (“CMS”), the American Medical Association (“AMA”), the American Hospital Association (“AHA”), and other relevant professional societies.

Several years ago Medicare implemented the OPPS (Outpatient Prospective Payment System) to pay hospitals for services provided in their outpatient departments. This system includes billing codes called “C-codes,” or “pass-through” codes. Medicare created more than 90 pass-through categories of devices and gave each category its own C-code (the letter “C” followed by four digits). If a hospital used a device that belongs to a pass-through category, it could put the appropriate C-code on the bill that it submitted to Medicare and receive an additional payment. These were commonly known as pass-through payments and were designed to expire after two to three years, after which the additional payments would be folded into the relevant Ambulatory Payment Classification (APC) payment rates.

Though the pass-through payments for most C-codes no longer exist, Medicare does require that C-codes continue to be included on hospital claims paid under the OPPS. This is done so that Medicare can adequately capture the resources required to provide services and can use this resource information to establish adequate payment rates in the future. In fact, Medicare has defined certain procedures as being device dependent, and claims for these procedures will be denied if they don’t also include the necessary C-code. See http://www.cms.hhs.gov/HospitalOutpatientPPS for additional information.

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