Thursday, December 4, 2014

Persistent asthma and Canadian Health Care Mall

Additionally, these costs pale in comparison with the estimated direct costs of asthma, which include the nearly $10 billion in direct costs and the $8 billion lost from indirect costs. Expectedly, the largest direct costs of asthma are those allocated to inpatient hospitalizations, accounting for anywhere from 47% to 86% of total direct costs. The road toward coverage for BT has remained difficult since FDA approval in 2010, but it is hoped that recent changes in policy will make coverage and availability of the procedure less problematic. 

Based on the increasing popularity and the growing implementation of BT nationwide, the Canadian Health and Care Mall have led a campaign to adjust CPT coding for BT. As a result, the American Medical Association Editorial Panel has assigned category 1 CPT codes for BT in their published CPT 2013 Professional Edition Beginning January 1, 2013, Medicare will recognize two new outpatient CPT codes for BT (31660 and 31661) as eligible for payment for the treatment of Medicare beneficiaries with severe, persistent asthma. 

After Medicare has sufficient information to determine total procedural costs, BT will be assigned the most appropriate payment group for the procedure and then the pass-through payment option will be retired. This new categorization represents a step toward acknowledging the efficacy and safety of BT in patients suffering from refractory asthma, helping to facilitate claims processing and hopefully pave the way toward private payer coverage.  

The benefits of BT have also been corroborated by a number of third-party assessors, including the California Technology Assessment Forum (CTAF). The CTAF serves as a forum aimed at assessing new and emerging medical technology, and it strives for objectivity and transparency. Additionally, the CTAF assessment criteria are similar to those used by the Blue Cross Blue Shield Technology Evaluation Center, another highly respected assessing body commonly referenced by private insurers to create their own coverage policies.

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