We have developed an information sheet to address the confusion and disputes about claiming of spinal fusion cages that are integral fixation devices (that is, product group 13.10.01 – Interbody, Integral Fixation) and additional components.
To help stakeholders resolve historical payment disputes for the benefits associated with the billing codes in product group 13.10.01 – Interbody, Integral Fixation, we have provided a list that shows each billing code and the date the listing was updated. From this date onwards, all claims for the billing code include the spinal fusion cage and all additional components.
Private hospitals and private health insurers can use this list to determine whether or not the outstanding or disputed claim met the Prescribed List requirements at the time the device was provided as part of hospital treatment.
