Treatment Reimbursement
The main drawback when it comes to RFA is that it’s considered new technology, and, in many cases, insurance does not reimburse for it.
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March 2022“I think if it’s going to be offered, it’s important that patients understand that they may have to pay out of pocket,” Dr. Steward said. “Patients who are seeking RFA may already be aware of this issue, but many are often not.” He added that patients also need to know that the procedure doesn’t completely remove the nodule, so they could need another RFA treatment and the remnant nodule may not appear as benign on subsequent US examination.
Many of Dr. Hands’ patients, she said, are now getting reimbursed for some portion of their procedure, even though they may initially be denied. “We provide them with an appeal letter that usually does the trick,” she said. “Some are approved before we even do the procedure.”
While reimbursement policies differ from state to state, Dr. Hands said that even some of her Medicare patients have been reimbursed. “A clinical note is vital to reimbursement, and documenting patient symptoms helps on the review process,” she said.
Is it worth investing in the training and equipment for doctors who are considering offering RFA? “It depends on how many of the procedures they do,” said Dr. Steward. “If you’re paid $5,000 cash for 50 patients a year, that’s a lot of money to cover the costs. If you do a couple patients and try to get the insurance company to reimburse, it’s probably not worth it financially at this time. This is a new tool for a select subset of patients with symptomatic, cytologically benign, large or enlarging thyroid nodules, as an alternative to traditional surgery. The coding and reimbursement has yet to catch up.”
Dr. Steward explained that Category III CPT codes are typically designed for new technology like RFA. A new Category III T code became available for laser ablation of thyroid nodules in January 2022, but it’s unclear if this would apply to radiofrequency ablation, otherwise performed as an unlisted code. “There’s an extensive process of new technology going from initial adopters to being commonplace,” he said. “I think it will take a few years before RFA is a common procedure that’s widely available, but as soon as insurance reimburses for it, it will become widely available.”
While offering RFA for benign thyroid nodules hasn’t yet paid off from a practice perspective for Dr. Steward, he said it has paid off in terms of benefit to an individual patient. Dr. Hand noted that the patients she has treated with RFA found her online, knew the costs, and wanted to avoid surgery so badly that none of them “batted an eye.” She’s currently overwhelmed with requests for the procedure.