Recently, some of you may have been approached by sales reps for Amnio Injections for plantar fasciitis, tendonitis, and other inflammatory soft tissue pathologies not associated with a wound. These products appear to be helpful in the treatment of inflammation while creating significant profits. The sales reps are stating that this is a covered treatment by Medicare and they will show you the Pain Management LCD which do allow for the injections of plantar fasciitis and tenosynovitis. What they cannot show you is coverage for the injectable amnio (manufacturer specific Q Code). The problem is if you do use these products Medicare will initially pay for them but sometime in the future (sometimes up to 3 years) they will ask for their money back! Under these circumstances will the rep refund you the money for the cost of their product.

 

Noridian actually does have a written policy denying coverage for injectable amnio for “itis.” I have reached out to NGS concerning this issue. They will only cover these products for the treatment of wounds. Currently they will be doing a review on only one particular manufacture but this will soon expand to include all of the injectable amnio Q codes. For this particular Q Code they will deny coverage.

 

The reasoning that the medical directors are denying these Q codes is because these products meet FDA requirements for chronic ulcer treatment only.

 

You can use these products, but they should be billed as cash! For more financial information and potential changes to our field of medicine, please view our legislative updates in our members-only area.

 

Have happy and safe holidays!

Michael Fein, DPM