I just returned from a Dr's office that was part of the FDA Charite clinical trials. He is now doing one level artificial disk installations. I was informed by his nurse that Medicare won't pay for artificial disks. I might have a chance if my secondary carrier will pay.

Does Medicare have an appeal process for denials of treatment? It seems like they must. If you can get your doctor to document your need and then submit it with your paperwork to try and get approval. You might want to have the doctor make a request for surgery to your secondary insurance also. I hope you can get insurance coverage somehow.

Cervie, I heard the same "non-payment" policy of Medicare. But I also heard that they will pay for hospital charges, right? That would leave the cost of the device and procedure; both of which may be negotiated (attempted, I should say).

That leaves you with more options -- and more work. But don't give up, keep asking questions, make phone calls, take notes...keep us posted too. Your progress (I believe in you!) will help other people as well!

http://adrsupport.org/groupee_common...icon_smile.gif

These articles discuss what part medicare will pay for now and indicates they are adding in more codes for them.

They will at this point pay for your biological disk to be removed but not I guess the artifical implant if I understand the article correctly. The first article gives the code you need for billing.

http://www.spine-health.com/PRO/medi...truggle01.html
http://www.devicelink.com/mx/archive/04/11/news3.html

Did your doctor's office say medicare will part for part?

Here's are some more new codes for implanting the disk. I am not sure if they have figured out what they will pay yet which might be part of the problem. It does sound like it's in the works though if they have set up codes for them.

http://www.cms.hhs.gov/medlearn/table6b04.pdf

Cervie Queen,
Good to see you here! I have AARP for supplemental insurance and it seems that everything I do is covered so far.. however, haven't tried any of the ADR stuff as the low back is covered by WC tho the cervical spine when time comes will be either this insurance or whatever else I have depending on circumstances.
I'm debating whether to have my husband add me to his insurance or not since it's PPO stuff. Good for Dental,Vision,and medication coverage (which I opted not to have and that probably isn't a good idea -very $$) tho not better for PCP and hate all that authorization stuff/process~

Looking around more I found the agenda for the begining of next year that has the latest codes

http://www.cms.hhs.gov/paymentsystem...ddendafy05.pdf

It looks like they are changing the codes from a code for just removing the old disk to a whole new code for artifical disks. It looks like the code they used to use 80.51 (remove old disk) is being replaced by codes 84.60 to 84.69 (implant/revise artifical disk).

I spoke to one of the top US ADR surgeons today. He says that Medicare will have a code for ADR in January. This implies that they will be paying for the procedure, but it is still unclear under what circumstances, and how much they'll pay. With the cost in the US of over $11,000 for the prosthesis, compared to 2 or 3 grand for fusion hardware... it's going to be a tough battle. First, it may be paid for within clinical trial guidelines, but that won't help my dear friend Cervie Queen at all.

Mark

Hi guys,

I spoke with Medicare today and they did tell me that they are covering the ADR now. However, they will not tell me what code to use. If anyone can help me with that I would very much appreciate it.

Thank you.

Never mind, I found it. Thanks anyway. http://adrsupport.org/groupee_common...icon_smile.gif

Nichole, what insurance company do you have? Where is the info on Medicare now covering ADR?

Thanks.

Brady