ANNULAR CLOSURE

Facility: Hospital Outpatient or ASC (Commercial Payors) Hospital ASC

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; 1 interspace, lumbar

Payor Priced Payor Priced

Revenue Codes

CPT/HCPCS Revenue Code Description

C1713 0278 Anchor/screw bn/bn, tis/bn

C9757 0360 OR Services

1 CPT is a registered trademark of the American Medical Association2 2020 CMS OPPS/ASC Final Rule, Addendum B (available on CMS website), 84 Fed. Reg. 218 (Nov. 12, 2019).3 2020 CMS OPPS/ASC Final Rule, Addendum AA (available on CMS website), 84 Fed. Reg. 218 (Nov. 12, 2019).

Commonly Billed Codes 2020

Diagnosis Coding

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

M54.30 Sciatica, unspecified side

M54.32 Sciatica, left side

Facility: Medicare Hospital Outpatient or ASC (National Average Payment)

Hospital Outpatient ASC

CPT1/HCPCS Description APC APC Payment2 SI Payment3 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; 1 interspace, lumbar

5115 $11,900.71 J1 $7,465.38 J8

C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)

Unassigned Unassigned N Not Utilized in ASC

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Facility: Hospital Inpatient

Possible MS-DRG Description 2020 MS-DRG Payment4

028 Spinal Procedures w MCC $34,990.09

029 Spinal Procedures w CC or Spinal Neurostimulators $20,072.48

030 Spinal Procedures w/o CC/MCC $14,220.98

Physician Services Hospital/ASC Commercial

CPT/HCPCS Description Medicare PFS - Facility5 Physician Fee

63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar

$1,014.48 Payor Priced

63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar

$1,354.80 Payor Priced

22899 Unlisted procedure, spine Local MAC Priced Payor Priced

2020 Medicare Facility RVU5

CPT Code Work RVU Facility PE RVU MP RVU Total Facility RVUs

63030 13.18 11.01 3.92 28.11

63042 18.76 13.57 5.21 37.54

22899 N/A N/A N/A N/A

4 2020 CMS IPPS Final Rule, Tables 1B, 1D and 5 (available on CMS website), 84 Fed. Reg. 159 (Aug. 16, 2019).5 2020 CMS PFS Final Rule, Addendum B (available on CMS website), 84 Fed. Reg. 221 (Nov. 15, 2019).

Facility: Hospital Inpatient

ICD-10-PCS Description

Lumbar/Lumbosacral Discectomy

0SB20ZZ Excision of Lumbar Vertebral Disc, Open Approach

0SB24ZZ Excision of Lumbar Vertebral Disc, Percutaneous Endoscopic Approach

0SB40ZZ Excision of Lumbosacral Disc, Open Approach

0SB44ZZ Excision of Lumbosacral Disc, Percutaneous Endoscopic Approach

Implantation of the Barricaid

0SU20JZ Supplement Lumbar Vertebral Disc with Synthetic Substitute, Open Approach

0SU40JZ Supplement Lumbosacral Disc with Synthetic Substitute, Open Approach

Barricaid Reimbursement Support

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. 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 20, 2020.

Telephone: (888) 325-9772 | Fax: (303) 474-3139

Email: reimbursement@barricaid.com

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