If you are a healthcare professional treating patients with discogenic back pain, you may have many questions about reimbursement for the IDET* procedure. While you’ll find some of the answers to your questions here, the best way to get answers to the questions you need is to work directly with your payor organization to determine payment methodology for the IDET procedure.

The IDET procedure is covered in 21 states by payors representing 32 million covered lives. It is also covered by the Federal employee health benefit. For more specific information, contact your payor organization directly, or use our Reimbursement calculation tools.

Private insurers have varying payment guidelines, especially regarding new procedures. Typically they base payment on charges, discounted charges, fee schedules or capitation. Payment amounts will vary based on contractual arrangements with the individual payors. Due to these arrangements, the insurer should be contacted for their specific payment guidelines regarding the IDET procedure.

The actual amount paid by Medicare to participating physicians is 80% of the fee schedule, or their actual charge, whichever is lower. Physicians are permitted to bill the Medicare beneficiary and/or secondary carrier for the remaining 20%. Non-participating physicians must collect their fee directly from the Medicare beneficiary. To view a Medicare Physician Fee Schedule, see Medicare physician policy.