Oppenheimer Notes Billing Confusion Impacting Inspire Medical
Oppenheimer notes that earlier Thursday morning, the Wisconsin Physicians Service Medicare Administrative Contractor updated its hypoglossal nerve stimulation Local Coverage Determination to state that physicians should "use modifier 52 with CPT 64582 to bill at a reduced rate for professional services when billing for implantation without the insertion of a distal respiratory sensor." The firm believes this will lead to further confusion within Medicare billing as Inspire Medical has stated to use Current Procedural Terminology code 64582 without the 52 modifier. Oppenheimer had previously written that there may be problems if both i4 and i5 were being billed using the same code without the modifier due to differences in respective relative value units. It is unclear if/when other MACs may follow suit, but having a difference between respective jurisdictions will likely create another headache for Perform-rated Inspire.
