What are the diagnosis and billing codes associated with ET and Cala therapy?
Diagnostic Code for Essential Tremor: ICD-10 G25.0. Cala Trio device is currently indicated for adults diagnosed with essential tremor.
HCPCS code K1018: “External Upper Limb Tremor Stimulator of the Peripheral Nerves of the Wrist.” This covers the prescription for the stimulator and base station.
HCPCS code K1019: “Replacement Supplies and Accessories for External Upper Limb Tremor Stimulator of the Peripheral Nerves of the Wrist.” This covers the monthly band subscription supplied every 90 days.
What is the difference between Coverage and Payment (also known as Reimbursement)?
The term “coverage” refers to the decision insurance companies make regarding whether a patient will have access or “coverage” to therapy like the Cala TAPS therapy. If a “coverage” policy exists within that insurance company, they would rely on that “coverage” policy and approve the requested therapy according to the rules/stipulations specified in that policy. If no coverage policy exists for Cala Trio therapy, then the coverage would be determined (approved or not approved) on a case-by-case basis.
The term “payment” refers to the amount the insurance company would provide for the Cala TAPS therapy and supplies, and/or reimbursement/payment to the healthcare provider for professional services. If the Cala TAPS therapy is a covered benefit by the patient’s insurance provider, a patient copay or deductible may be required based on the benefit plan.
What documentation is needed to establish Medical Necessity to obtain health benefits coverage?
Please refer to the prescribing requirements and documentation considerations in the prescription kit.