What are the rules for this (20974). To bill for a bone stimulator I thought the doctor must be present and a note must be dictated. Dr wants to bill for an office visit plus application of bone stimulator.
An office visit and the bone stimulator may both be reported IF the guidelines for the 25 modifier are met. If the patient is only being seen for treatment with the bone stimulator then an E/M should not be reported in addition to the 20974.
External Bone Stimulators. Code 20974 (electrical stimulation to aid bone healing; noninvasive) should be used for the placement of an external bone stimulator. Medicare considers that there is insufficient evidence to support the medical necessity of using a stimulator for treating nonunions of the skull, vertebrae or those that are tumor-related. In addition, Medicare will not cover ultrasound stimulation for fresh fractures. Coverage guidelines for Medicare may be different from the coverage criteria of many private insurers. Check with your local carriers for more details.
An external bone stimulator is usually only covered for nonunion of long bone fractures; failed fusion, when a minimum of nine months has elapsed since the last surgery; congenital pseudarthroses; and as an adjunct to spinal fusion surgery for patients at high risk of pseudoarthrosis due to previously failed fusion at the same site or for those undergoing multiple-level fusion.
Follow-up for an external bone stimulator would usually be covered during office visits (99211-99215).
Purchased or Leased? The actual stimulator is usually purchased by the hospital, and unless an approval was given by the payer to buy and bill the internal device, you should probably leave it to the hospital.
An external stimulator is typically leased as DME (durable medical equipment) by the patient from the manufacturer. If you are dispensing them to the patient out of your office, they are typically billed under HCPCS E0747 (osteogenesis stimulator, electrical, nonivasive, other than spinal applications) or E0748 (... spinal applications) as a flat-fee lease.