MEDTRONIC REIMBURSEMENT SUPPORT PROGRAM

1 OPTIMIZE YOUR REIMBURSEMENTYour dedicated Regional REIMBURSEMENT Manager is available to assist you and your staff with: General REIMBURSEMENT and coverage questions REIMBURSEMENT and coding tools Education and training Contact your Regional REIMBURSEMENT Manager at 888-389-5200, option 1. STREAMLINE YOUR CLAIMS PROCESSINGM edtronic offers benefit verification and claims SUPPORT through a no cost PROGRAM administered by The Pinnacle Health Group. Providers can enroll to receive assistance with patient specific SUPPORT related to: Verification of coverage and benefits Prior authorization Denial or appeal assistanceA Business Associate Agreement is required to participate in this PROGRAM .

2 Contact your REIMBURSEMENT Manager or Pinnacle directly to request a copy of the enrollment document. Verification of benefits will be completed within 5 days of a submitted The Pinnacle Health Group assistance PROGRAM at 888-389-5200, option 2 or WE RE HERE TO HELPTake advantage of the insight and experience of our provider SUPPORT teams to facilitate the payer process for your (1)a(2) 2018 MEDTRONIC . All rights reserved. MEDTRONIC , MEDTRONIC logo and Further, Together are trademarks of MEDTRONIC . All other brands are trademarks of a MEDTRONIC company. As you deliver state-of-the-art care to your patients, your staff will be learning new codes and the REIMBURSEMENT process. We offer tools and guidelines that assist your staff in working efficiently and effectively.

3 Your MEDTRONIC Regional REIMBURSEMENT Manager can assist with any REIMBURSEMENT questions or economic REIMBURSEMENT SUPPORT PROGRAM2 Capsule EndoscopyProcedureCPT CodeCPT Code Definition12018 medicare National Average Allowable AmountHospital Outpatient2 Physician3 PillCam SB 3 system91110 Gastrointestinal tract imaging, intraluminal ( , capsule endoscopy), esophagus through ileum, with physician interpretation & report $ 74 3 . 4 9 Global: $ *Pro Fee: $ Work RVU PillCam UGI system91299 Unlisted diagnostic gastroenterology procedure$ PricedPillCam Crohn s system91299 Unlisted diagnostic gastroenterology procedure$ PricedPillCam Patency system91299 Unlisted diagnostic gastroenterology procedure$ PricedPillCam COLON 2 system0355 TGastrointestinal tract imaging, intraluminal ( , capsule endoscopy), colon with physician interpretation & report $ 14 2 7.

4 3 9 Carrier PricedMotility TestingProcedureCPT CodeCPT Code Definition12018 medicare National Average Allowable AmountHospital Outpatient2 Physician3 SmartPill motility testing system91112 Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report$ 74 3 . 4 9 Global: $ Fee: $ RVU ManoScan high resolution manometrysystem91010 Esophageal motility (manometric study of the esophagus and or gastroesophageal junction) study with interpretation and report $ : $ Fee: $ RVU AR 3D probe91122 Anorectal manometry$ : $ Fee: $ testing is not a covered benefit in the Ambulatory Surgical Center (ASC) for medicare beneficiaries.

5 For patients with commercial insurance, benefit verification prior to use is recommended. *Section 5102(b) of the Deficit Reduction Act of 2005 requires a payment cap on the technical component of certain diagnostic imaging procedures and the technical component (TC) portions of the global diagnostic imaging services. This cap is based on the hospital outpatient payment. To implement this provision, the physician fee schedule amount is compared to the hospital outpatient payment amount and the lower amount is used for payment. Capsule endoscopy is not a covered benefit in the Ambulatory Surgical Center (ASC) for medicare beneficiaries. For patients with commercial insurance, benefit verification prior to use is CodeCPT Code Definition12018 medicare National Average Allowable AmountHospital Outpatient2 Ambulatory Surgical Center (ASC)4 Physician3 EndoFlip impedance planimetry system91040 Esophageal balloon distension study, diagnostic, with provocation when performed$ impedance planimetry is not a covered benefit in the ASC for medicare beneficiaries.

6 For patients with commercial insurance, benefit verification prior to use is : $ Fee: $ RVU pH-Z testing system91034 Esophagus, gastroesophageal reflux test; with nasal catheter ph electrode(s) placement, recording, analysis and interpretation$ testing is not a covered benefit in the ASC for medicare beneficiaries. For patients with commercial insurance, benefit verification prior to use is recommended. Global: $ Fee: $ RVU reflux testing system91035 Esophageal gastric reflux test with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation$ $ $ medicare covers 91035 in the ASC when provided integral to another surgical procedure.

7 For additional information, please contact your field REIMBURSEMENT : $ Fee: $ RVU high resolution manometry system91037 Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation$248 . 83 Reflux testing is not a covered benefit in the ASC for medicare beneficiaries. For patients with commercial insurance, benefit verification prior to use is recommended. Global: $ Fee: $ RVU pH-Z testing system91038 Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to 24 hours)$ testing is not a covered benefit in the ASC for medicare beneficiaries.

8 For patients with commercial insurance, benefit verification prior to use is : $ Fee: $ RVU Testing4 Radiofrequency AblationHemorrhoid Energy TherapyProcedureCPT CodeCPT Code Definition12018 medicare National Average Allowable AmountHospital Outpatient2 AmbulatorySurgical Center (ASC)4 Physician3 Barrx radiofrequency ablation system43229 Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)$2, $1, 0 Pro Fee: $ RVU radiofrequency ablation system43270 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)$1, $ 6 2 7.

9 4 3 Pro Fee: $ RVU radiofrequency ablation system43255 Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method$ 1 , 4 2 7. 3 9$ 6 2 7. 4 3 Pro Fee: $ RVU radiofrequency ablation system 45334 Sigmoidoscopy, flexible; with control of bleeding, any method$ $ Fee: $ RVU AnorectalR FA w a n d46615 Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique$2, 315 . 63$1,139. 05 Global: $ Fee: $ RVUs Bipolar System46930 Destruction of internal hemorrhoid(s)by thermal energy (eg, infraredcoagulation, cautery, radiofrequency)$ $14 8 . 32 Global: $ Fee: $ RVUs 5GI Biopsy Procedures using Beacon EUS delivery system and needles References: 1.

10 CPT copyright 2018 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. No fee schedules, basic units, relative values, or related listings are included in CPT . The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. 2. CY 2018 Hospital Outpatient Perspective Payment System Final Rule, valid through Dec 31, 2018. 3. CY 2018 Physician Fee Schedule Final Rule, valid through Dec 31, 2018 4. CY 2017 Ambulatory Surgical Center Payment System Final Rule, Valid through Dec. 31, information is from materials published by the Centers for medicare and Medicaid Services (CMS) and the American Medical Association (AMA).