The Patient Advocacy Program (PAP) looks forward to working with you to provide reimbursement support. PAP can be contacted at:
Phone: (844)-288-7474 | Fax: (844) 288-2660
Email: reimbursement@barricaid.com
Commonly billed codes
It is the provider’s responsibility to select the most specific codes to report a patient’s condition and services rendered. The following may provide applicable coding information for the Barricaid treatment. Some payors may have unique coding requirements; please verify coding with the health plan.
Diagnosis coding
Barricaid is indicated for reducing the incidence of reherniation and reoperation in skeletally mature patients with radiculopathy (with or without back pain) attributed to a posterior or posterolateral herniation. Confirmation for treatment should be established by history, physical examination and imaging studies which demonstrate neural compression using MRI to treat a large annular defect (between 4-6mm tall and between 6-10mm wide) following a discectomy procedure (excision of herniated intervertebral disc) at a single level between L4 and S1. Listed are the most commonly billed ICD-10 diagnosis codes which may be appropriate based on the patient’s condition(s) and history.
For full instructions for use, please click here.
| ICD-10-CM | Description |
|---|---|
| M51.06 | Intervertebral disc disorders with myelopathy, lumbar region |
| M51.16 | Intervertebral disc disorders with radiculopathy, lumbar region |
| M51.17 | Intervertebral disc disorders with radiculopathy, lumbosacral region |
| M51.26 | Other intervertebral disc displacement, lumbar region |
| M51.27 | Other intervertebral disc displacement, lumbosacral region |
| M51.36 | Other intervertebral disc degeneration, lumbar region |
| M51.37 | Other intervertebral disc degeneration, lumbosacral region |
Physician coding & Medicare payment information
| Physician Services | Hospital/ASC | |
|---|---|---|
| 63030 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, single interspace; lumbar. | $938.87 |
| or | ||
| 63042 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar. | $1,243.51 |
| 22899 | Unlisted procedure, spine | Local MAC Priced |
Click here for Commonly Billed Codes – PDF
Facility Hospital Outpatient or Ambulatory Surgery Center (ASC) -National Average Payment
Hospital Outpatient
| CPT/HCPCS | Description | APC – Hospital Outpatient | APC Payment | SI |
|---|---|---|---|---|
| C9757 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone-anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1interspace; lumbar. | 5115 | $12,314.76 | J1 |
| C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) | N/A | N/A | N |
Ambulatory Surgical Center (ASC)
| CPT/HCPCS | Description | ASC Payment | PI |
|---|---|---|---|
| C9757 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone-anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1interspace; lumbar. | $7,666.65 | J8 |
| C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) | Not Reported in ASC | — |
Hospital Outpatient or Ambulatory Surgery Center (ASC) Commercial
| CPT/HCPCS | Description | Outpatient Hospital Payment | ASC Payment |
|---|---|---|---|
| C9757 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone-anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1interspace; lumbar. | Payor Priced | Payor Priced |
Disclaimer: Healthcare providers are solely responsible for reporting the codes that accurately describe the services provided to a particular patient as well as the patient’s medical condition or diagnosis. Providers should follow payor-specific billing and coding requirements and contact the payor if they have questions. Note that the existence of a code for a procedure does not guarantee coverage or payment. This guide includes Medicare national average payment rates rounded to the nearest dollar. Payment rates to individual providers will vary based on geographic location and other provider-specific factors, including participation in various quality programs. The information included herein is shared for educational purposes only and does not constitute legal advice. The information is based upon publicly available information. Providers are reminded that reimbursement is dynamic. Codes, coverage, and payment rates change, at minimum, on an annual basis, and may be changed periodically throughout the year. The information is current as of February 10, 2020.
Prior authorization
Medicare
Prior authorization is not required for Medicare patients receiving their benefits through the original Medicare system.
Commercial health plans & Medicare Advantage
Prior authorization for Barricaid is usually required by commercial health plans and Medicare Advantage plans.
To assist you in the prior authorization process, Intrinsic Therapeutics, Inc. provides a prior authorization team to assist you with Barricaid cases.
Prior authorization denials
For additional guidance contact the Patient Advocacy Program at 888-325-9772, or by email at reimbursement@barricaid.com.
Frequently asked questions
Medicare
Please refer to the Commonly Billed Codes section of this page, or the Commonly Billed Codes PDF for national unadjusted Medicare Hospital Outpatient and Ambulatory Surgery Center payment levels. Please verify your specific payment levels with your local Medicare carrier.
Non-Medicare
It will be at the discretion of the individual health plan whether they will require CPT codes or HCPCS codes for hospital outpatient or Ambulatory Surgery Center Barricaid claims. Please verify appropriate coding with the health plan. Non-Medicare reimbursement levels may be calculated based on a percentage of the Medicare hospital outpatient fee schedule, ASC fee schedule or negotiated contracts.
Health insurance coverage and payment
A number of health plans may cover Barricaid when medical necessity has been established. For information regarding a specific insurance company, please contact the patient’s insurance plan or the Patient Advocacy Program (PAP) at 888-325-9772.
a. The Barricaid procedure has an assigned HCPCS code that is reported for hospital/ASC billing and an unlisted CPT code is reported for physician billing. The codes submitted for authorization may vary based on site of service. When submitting for a prior authorization, you may have to prior authorize both the CPT code for physician services and the HCPCS code for facility billing.
b. The PAP can assist the physician’s office staff to determine the payor approval process for submitting prior authorization requests and will submit on the behalf of the patient if the patient is participating in the PAP.
Coding varies based on provider, site of service and payor requirements. For example, the physician may report:
a. CPT 63030- Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar
OR
b. CPT 63042 – Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar
AND
c. CPT 22899 – Unlisted procedure, spine
The hospital outpatient department will report:
a. C9757 – Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar; and
b. C1713 – Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable). (The ASC will report only C9757.
For complete coding descriptions see the Barricaid Commonly Billed Codes PDF.
The physician will determine if the patient is a candidate for the Barricaid, which is indicated for patients who have a large annular defect, i.e. 4-6mm in height and 6-10mm in width, at a single level between L4 and S1.
Please contact your Barricaid Sales Representative for pricing information.
It is important to appeal prior authorizations and claim denials. If there are questions regarding appealing prior authorizations or claims, please contact the relevant payor or the Barricaid PAP at 888-325-9772.
We recommend that you confirm medical criteria with the specific health plan as requirements may vary.
The physician must decide the appropriate examinations to conduct based on his or her clinical experience. The FDA does have certain indications including that the patient be skeletally mature with radiculopathy (with or without back pain) attributed to a posterior or posterolateral herniation, and confirmed by history, physical examination and imaging studies which demonstrate neural compression using MRI. In addition to these requirements, the patient’s health plan may require additional diagnostic examination(s).
Yes, the Barricaid implantation procedure is performed using fluoroscopic guidance. Image guidance is included when billing C9757.
Support documents
Key clinical information – Click here to view/download Publication Synopsis & here for Published Evidence List
Barricaid billing guides – Click here to view/download Commonly Billed Codes
Patient Advocacy support – Click here to view/download Patient Advocacy Program Brochure
Patient Advocacy support – Click here to view/download PAP Process Flowchart
Society support – Click to view ISASS Policy Guideline
FDA documentation – Click to view PMA Approval Letter
