I was unable to hear regarding the PESA reimbursement in regards to, I think we all decided that unfortunately you now need to become a DME certified supplier potentially as a private practice to be able to bill the DME fee schedule, but I've done some research on this personally myself and it's not straightforward because there seems to possibly be some exemptions for physician integral supplies to physician services. So I would encourage everyone to contract their Medicare contractor who does PESA-free in their office and provides the PESA-free and wants to bill the A code directly versus writing the script to a DME distributor to check in with your Medicare contractor to make sure what the requirements are. We're actually working through that right now trying to figure out if that ought to be part of the practice expense and we'll be on the call Monday night. Because the reality is you can't do the procedure without the pessary. Exactly. Which technically isn't an integral part of the procedure, which technically would meet the requirement. Well, the way we're presenting it to RUC is that we're going to do a practice expense of a pessary fitting kit, and so then the practitioner... Well, and the fitting kits, right, don't include the actual pessary that the patient goes home with. It's a pessary that can be worn for 20 minutes, and so then that comes out and then you order that size. It's like trying on shoes. So, maybe we could say that the pessary is part of the pessary fitting kit, I don't know. We're working on it. Anyway, but this is an area of some confusion, so call your Medicare contractor or send them an email and make sure before you start billing a bunch of A codes. I pulled down the laparoscopic colpopexy thing from... Yes, sir. So, it's worded in here, preferred alternative code is the 58999, but then it says in here, with reference to either CPT code 57283 or 57270, so is it suggesting that when you dictate, you're comparing? No. What they're saying there is when you submit that 999, the unlisted code, you want to send them a letter with references to what you think it's worth, and you're going to reference those other codes based on the amount of work, so they can then determine your RVU that it's worth. That's part of, and that's why it affects your revenue cycle, because it's all done by hand, and Mark Toglia was telling me a couple weeks ago, he did that, it took him almost two years to get reimbursed for it. I know. No. I'm not sure why that happened. I know. So, that would be a procedure that you would list with a 25 modifier, and they should cover that, and so if you're getting those kind of responses on your EOB, you need to, I'm not sure, if it's on the same day, they're either going to deny it, yeah, it might be they just didn't put the modifier down.

PESA reimbursement

DME certified supplier

physician integral supplies

pessary fittings

unlisted codes