Was Your Virtual Surgical Planning Covered By Insurance?

[PierreDeFermat]

I'm having surgery at the end of April and the company my surgeon uses to perform Virtual Surgical Planning (VSP) does not accept insurance, so I had to pay that fee upfront (though they payment was processed through my surgeon, a preferred provider).

Has anybody tried to submit a claim to their insurance for VSP? If so, which codes did your provider submit it as? Was it one larger charge or did they include it as part of a battery of diagnostic services (x-rays, impressions, etc.)?

I'm going to call my insurance (Fep Blue) today and ask if I can bill it as a CPT 76377:

"3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation."

[PierreDeFermat]

EDIT: I will possibly be submitting the CPT 76377 with diagnosis code ICD-10-CM Diagnosis Code G47.33 for Obstructive Sleep Apnea (OSA), which was the reason for my surgery in the first place.

[runrabbitrun]

Hi there!

So, same exact situation on my end - surgeon told me that VSP would be the only aspect of the surgery that I'd have to pay out-of-pocket; payment would need to be made upfront upon scheduling the surgery. The way his coordinator spoke about it made it seem as though this wasn't a case-by-case thing - that VSP was never covered by insurance. My guess would be that VSP is still considered experimental and/or investigational since other methods can be used for more or less the same result.

Since my VSP payment was processed by the surgeon's office as well, I paid for it using FSA funds. Not sure if you have an FSA, but that may be an option for you if you're unable to get it covered!

[PierreDeFermat]

No FSA for me unfortunately, I had to pay cash up front upon scheduling of the surgery.

My surgeon's office said it was something about there being no specific code for the modeling but nonetheless I'm gonna gather all the documents, published studies, invoices, etc. and try to submit a claim; It's little work to hopefully get back some of the $3500. My position is that it is medically necessary and an integral part of the surgery, so they're obligated to pay for it as part of the procedures they've already approved.

I'll report back after their decision.

[PierreDeFermat]

Upon further research I've found a new CPT Code which I believe is more accurate:

21085, Under Head Prosthesis Preparation: Impression and custom preparation; oral surgical splint

[runrabbitrun]

[quote=PierreDeFermat post_id=501282 time=1522644336 user_id=31191]
Upon further research I've found a new CPT Code which I believe is more accurate:

[b]21085[/b], Under Head Prosthesis Preparation: [i]Impression and custom preparation; oral surgical splint[/i]
[/quote]

I think you're right - seems like that code is more likely to be approved. Not sure if this is helpful documentation (it's a bit out of date), but it specifies that imaging should be covered: https://www.aaoms.org/images/uploads/pd ... _apnea.pdf.

Please do let me know what you find out! My imagining was only $1500, but still worth getting it reimbursed if I can. From the few studies I've read about VSP vs traditional methods, VSP results in better patient outcomes, which seems like common sense. So frustrating that stuff like this is considered "experimental."

[runrabbitrun]

Not sure if this is helpful, but I just received my itemized receipt from my surgeon, and I feel like there's no reason this shouldn't be reimburse-able?

VSP charges were listed with the following bill codes:

• CPT 70486, Under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck

• M26.10 - Unspecified anomaly of jaw-cranial base relationship

• G47.33 - Obstructive sleep apnea (adult) (pediatric)

I'll likely look into this early next week - I'll let you know what I find out!

[PierreDeFermat]

A CPT code is procedure, in this case the doctor took a scan of your head. It was covered by your insurance (check your EOB for details).

The other two are diagnosis codes which describe your condition and why you required the scan done.

I'm still trying to ask around for the proper CPT codes for the VSP...