The IDET^◊ procedure is paid by some Medicare and private payors, provided the service meets all of the coverage and payment requirements established by the individual payor. It is critical that claims for payment be coded appropriately and supported with adequate documentation in the medical record.

• It always is advisable to contact your local Medicare contractors and other payors to verify their coverage and payment rules regarding the IDET^◊ procedure and to determine if the payor has any special coding or documentation requirements you are expected to follow. Providers should verify these requirements in writing with local payors.
• It is always the provider’s responsibility to determine and submit appropriate codes, charges and modifiers for filing claims. Accurate coding may lead to faster processing of submitted claims. The information provided here is a guide only. Documentation is key to communicating to a payor the essential information necessary for deciding whether a procedure or service was reasonable and medically necessary for a particular patient and whether a procedure or service should be paid. Medical record documentation is also important in explaining why a particular modifier was added to a claim.
• At a minimum, a patient’s medical record should convey information about the patient’s medical condition, the rationale for why the IDET^◊ procedure is the treatment of choice for the patient, and the outcome of the procedure.
• Documentation in the medical record contains valuable information that enables the physician's billing personnel to verify that a claim is coded specifically and accurately.

For more information on:

• Coding Guidance
• Pre-Certification/Prior Authorization
• Management of appeals and denials

Please call 1-877-333-IDET^◊

For further information about insurance and reimbursement related to the IDET^◊ procedure, call 1-888-711-9903 or review the following resources: