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Medicare coding for maggots and maggot therapy
Date:11/10/2008

Today, the BioTherapeutics, Education & Research (BTER) Foundation was notified that the American Medical Association (AMA), in collaboration with the Centers for Medicare and Medicaid Services (CMS) have just issued reimbursement coding guidelines for medicinal maggots and maggot therapy.

Appearing in the September, 2008 edition of CPT Assistant (Vol 18, Issue 9, page 11), the coding advisors wrote:

". . . . [CPT code] 97602 may be [used to report maggot therapy], as it is a type of nonexcisional debridement. To further clarify, the Centers for Medicare and Medicaid Services Transmittal 5, dated November 19, 2004, included maggot therapy as a type of debridement . . . . The supply of maggots should be reported in addition to the wound management code 97602 with CPT supply code 99070, Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies or materials provided)."

Earlier this year, the BTER Foundation formally requested that the AMA and CMS provide better guidance or specific codes to improve medical record documentation of maggot therapy and requests for reimbursement. In April, BTER Foundation Board Members Ronald Sherman of Irvine, California, and Pamela Mitchell from Akron, Ohio, were invited to appear at a public hearing at Medicare's Baltimore headquarters. They brought with them dozens of letters from maggot therapists and patients frustrated by their difficulties getting reimbursed by insurance companies and Medicare subcontractors for their maggot therapy expenses. Medicare officials were quite sympathetic to the requests for better coding and processing of insurance claims for maggot therapy, explaining that product coding and reimbursement needed to be coordinated with procedural coding and reimbursement.

In a letter received today by Dr. Sherman, Director of the BTER
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Contact: Ronald Sherman
RSherman@BTERFoundation.org
BioTherapeutics, Education & Research Foundation
Source:Eurekalert  

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