A service is considered to be performed in a hospital outpatient department when the service is performed in a facility that is administratively and financially linked to a hospital, and the patient is registered at the hospital but not admitted as an inpatient (i.e., no overnight stay or less than 24-hour stay with overnight admission). The following information may be useful to hospitals submitting claims for the IDET* procedure:

Modifiers indicate that a service was altered in some way from the stated CPT descriptor without changing the definition. The American Medical Association (AMA) CPT modifiers are two-digit numeric codes listed after a procedure code and separated from the CPT code by a hyphen. The following CPT modifiers may be relevant to the IDET procedure:

CPT Modifier Description
-53 Discontinued Procedure (HCFA-1500)
-73 Discontinued Out-Pt/ASC procedure before Anesthesia administered (UB-92)
-74 Discontinued Out-Pt/ASC procedure after Anesthesia administered (UB-92)

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Medicare reimburses for hospital outpatient services under a prospective payment system (PPS).

  • Payment under the hospital outpatient PPS depends on what item or service is furnished to a patient and to what APC that item or service is grouped.
  • Cases are assigned to an APC group based on the CPT and HCPCS codes reported by the facility.
CPT Code Description APC National Medicare OPPS Fee Schedule
22526 Percutaneous electrothermal intradiscal annuloplasty,  unilateral or bilateral including fluoroscopic guidance; single level 0050/T $1,859.23
22527 One or more additional levels (List separately in addition to 22526 for primary procedure) 0050/T $1,859.23

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Procedure codes indicate the surgical and/or diagnostic procedures performed on the patient. Hospital outpatient/inpatient claims must report the appropriate ICD-9-CM procedure codes. The following ICD-9-CM procedure code may apply to patients undergoing IDET:

ICD-9 Description CPT Cross Reference
80.59 OTH EXC/DEST INTVRT DISC

22526, 22527

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Private insurers cover hospital outpatient services that are considered medically necessary and within the benefit structure of the patient’s health insurance coverage.

  • Payment for the IDET procedure may be based on a percentage of the billed or allowed charges, per diem, or on a negotiated payment rate.
  • Check with your payor organizations to determine the payment methodology for the IDET procedure.

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For further help with insurance and reimbursement, use our Reimbursement Calculation Tools.