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Reimbursement

A FibroScan® based risk stratification strategy can reduce liver disease diagnosis and management costs, resulting in a better allocation of resources. 

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FibroScan® is reimbursed under CPT code 91200

As part of an overall care management plan, FibroScan® examinations can lead to reduced costs, improved outcomes, and improved patient satisfaction. Care delivery models featuring FibroScan® are currently in practice or in development.

NASHNet hospital systems have already started to generate real world evidence to support FibroScan® based platforms to more efficiently and effectively identify and manage patients with fibrotic-NASH in the hospital setting.

FibroScan® enhances population health management by improving diagnosis accuracy at the point of care to allow for better accounting for health risks among the populations served.

Provider & Health Plan Benefits

  • Improves access to care.
  • Provides testing at the point of care to reduce unnecessary specialist referrals and allow for earlier, targeted interventions.
  • Painless and takes less than 10 minutes, with minimal patient preparation and limited disruption in patient workflow.
  • Non-invasive technology allows physicians to easily estimate liver stiffness and fat content.
  • Quantitative assessment that allows consistent tracking of liver health longitudinally.
  • An aid in the risk stratification of patients to identify those in need of further treatment.
  • Establishes liver health in the chronic care management of patients with metabolic syndrome.

 

Hospital coding guide

FibroScan® devices are FDA cleared as an aid to diagnose and monitor adult patients with liver disease, as part of an overall assessment of the liver. FibroScan® devices utilize proprietary VCTE™, which applies a mechanically induced shear wave and does not utilize diagnostic imaging.

Testing is covered under category I CPT code 91200

Liver elastography, mechanically induced shear wave (e.g. vibration), without imaging, with interpretation and report: CPT Code 91200 for 2020.

HOSPITAL OUTPATIENT MEDICARE PAYMENT $140.33 (APC 5721)
*CMS Hospital Outpatient Prospective Payment System 2020 Final Rule – CMS 1717-FC

Yes, testing billed under CPT category 1 code 91200 is specific to the FibroScan® examination.

Hospital outpatient clinics performing the FibroScan® examination should bill 91200. Coverage and payment of FibroScan® examination may vary by commercial payers.

The physician charging for test interpretation and reporting will bill 91200-26 which is 0.40 RVU. Coverage and payment for FibroScan® examination may vary by commercial payers.

Echosens maintains a Reimbursement Hotline at (866) 905-4837, option number 4.

Physician office coding guide

FibroScan® Testing is Covered Under Category I CPT Code 91200.
Liver elastography, mechanically induced shear wave (e.g. vibration), without imaging, with interpretation and report: CPT Code 91200 for 2020.

PHYSICIAN OFFICE MEDICARE PAYMENT $37.89 (1.05 RVU)
*CMS Physician Fee Schedule CY2020 Final Rule CMS-1715-F. Conversion Factor 36. 09

Yes, category 1 CPT code 91200 is specific to the FibroScan® examination.

Physician offices performing the FibroScan® examination should bill 91200. Coverage and payment of a FibroScan® examination may vary by commercial payers.

Echosens maintains a Reimbursement Hotline at 866-905-4837, option number 4.