Novitas Proposes LCD Preventing Reimbursement for Venous Stenting Performed in Physician Offices and Office-Based Labs

October 3, 2018

Novitas Solutions Inc. issued a proposed local coverage determination (LCD) that would prevent physicians from being reimbursed for providing venous stenting services to Medicare beneficiaries when performed in a physician office (POS-11) setting. Physicians commonly perform such minimally invasive procedures in their offices and in office-based labs to treat patients suffering from chronic venous disease, venous thrombosis and venous stenosis. Chronic venous disease is prevalent in the United States, affecting more than 6 million adults. If the proposed LCD is implemented in its current form, Novitas would reimburse providers for these services only when they are performed in certain hospital-based settings (POS-19, 21 or 22) or in an ambulatory surgery center (POS-24).

The Centers for Medicare & Medicaid Services relies on a network of Medicare administrative contractors such as Novitas to serve as the primary operational contact between the Medicare fee-for-service program and the healthcare providers enrolled in the program. Novitas processes Medicare Part A and Part B claims for providers and suppliers in Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, Mississippi, Delaware, the District of Columbia, Maryland, New Jersey and Pennsylvania, who would be impacted by this new policy.

Interventional physicians and their related trade groups and medical societies are concerned that this new policy could significantly adversely impact the availability of venous stenting services, especially in rural communities, and expressed confusion over the proposed policy change since physicians have been performing these services safely and effectively in a physician office setting for many years.

Novitas will hold an open meeting at its headquarters in Mechanicsburg, Penn., on Oct. 4, 2018, to review the proposed LCD. A number of trade organizations and physicians plan to present at this meeting in an effort to encourage Novitas to reconsider its proposal. Interested stakeholders may submit comments on the proposed LCD during the 45-day comment period, which ends Nov. 8, 2018. Please contact the author below if you have questions about the content of this McGuireWoods Legal Alert or if you are interested in commenting on the proposed LCD.