To Our Valued Customers:

As we continue to wait for the impending reimbursement rate decision from Palmetto GBA and the other Medicare Administrative Contractors (MAC) for the new global and technical CPT codes (93241, 92343, 93245, 93247) for long-term continuous ECG monitoring, we want to share with you how we are advocating on your and your patients’ behalf, and how you can help, in light of the recent Novitas Solutions reimbursement decision.

What Happened
On January 29, 2021, Novitas Solutions Inc (Novitas), a Medicare Administrative Contractor, established reimbursement rates for the new global and technical CPT codes (93241, 92343, 93245, 93247) for long-term continuous ECG monitoring. Unfortunately, these new rates fall far short of those originally proposed by CMS in the 2021 Medicare Physician Fee Schedule Proposed Rule1. We are astonished and disappointed by the direction Novitas has taken with its announcement of a 74% average reduction in the global codes.

We believe the Novitas decision is at odds with science and extensive clinical data demonstrating the clinical benefits over traditional Holter monitors and increased diagnostic yield2. The additional physician effort and advances in ECG technology over that of traditional Holter warrant appropriate reimbursement.

Read More: Cardiac Insight Comments on Medicare Administrative Contractor Novitas Rate Publication

What We’re Doing
We have contacted Novitas as well as the other MACs, including Palmetto GBA. In addition to our communications with the MACs, we have reached out to the leading professional cardiovascular medical societies, and are also in the process of reaching out to patient advocacy organizations throughout the U.S. We will ensure they are aware of this decision and its impact on patients and access to critical cardiac health diagnostics.

We also remain in close contact with our valued customers. Our priority is ensuring our customers have the support and supply of Cardea SOLO™ ECG Test Kits they need to continue providing diagnoses and care for their patients throughout this evolving process.

How You Can Help
As a healthcare provider, you can make the biggest impact by calling Novitas directly to express your concern and convey how this decision will greatly impact patient care. If you prefer to write to Novitas Solution’s Chief Medical Director, we’ve prepared the template letter below for your use. Lastly, we encourage you to reach out to your local legislative representatives as well as your national and local medical associations. We have included the contact information below.

ACC Advocacy: advocacyleg@acc.org

HeartPAC | Find A Local Legislator

HRS Member Services: membership@hrsonline.org

Physician Letter To Novitas

If you prefer to send a letter to Novitas Solutions, we have created a Physician Template Letter where you can add your logo and practice information.

You can submit your written communication online using the links below.

Download Now

 

Contact Novitas Solutions

Your phone calls to Novitas Solutions will make a difference. Call your local Novitas office today to convey your concern and how your patients will be negatively impacted by the reimbursement decision. 

Locations:
Arkansas
Colorado
Louisiana
Mississippi
New Mexico
Oklahoma
Texas

Phone: (855) 252-8782

Fax: (877) 439-5479

Submit An Online Form

Locations:
Delaware
District of Columbia
New Jersey
Maryland
Pennsylvania
Virginia (Counties: Arlington, Fairfax, and the City of Alexandria)

Phone: (877) 235-8073

Fax: (877) 439-5479

Submit An Online Form

Novitas Solutions, Inc. Appeals Process

General Guidelines and Instructions Click Here

Redetermination 1st Level Appeal (must be submitted within 120 days from the date of initial determination) Click Here

Redetermination 2nd Level Appeal (used if 1st level appeal is denied. Must be submitted with 180 days from the date of receipt of the redetermination (level 1) decision) Click Here

Redetermination Status Click Here

 

 

Contact Palmetto GBA

Like many of you, we continue to wait for the impending reimbursement rates from Palmetto. Your phone calls to Palmetto will make a difference. Call your local Palmetto office today to convey your concern regarding reimbursement decision time and rates.

Palmetto Jurisdiction M:

North Carolina

South Carolina

Virginia

West Virginia

Phone: (855) 696-0705

Submit An Online Form

Palmetto Jurisdiction J:

Alabama

Georgia

Tennessee

Phone: (877) 567-7271

Submit An Online Form

Palmetto GBA Appeals Process

North Carolina, South Carolina, Virginia, West Virginia

General Guidelines and Instructions Click Here

Redetermination 1st level Appeal (must be submitted within 120 days from the date of the initial determination) Click Here

Redetermination 2nd Level Appeal (used if 1st level appeal is denied. Must be submitted with 180 days from the date of receipt of the redetermination (level 1) decision) Click Here

Redetermination Status Click Here

Alabama, Georgia, Tennessee

General Guidelines and Instructions Click Here

Redetermination 1st level Appeal (must be submitted within 120 days from the date of the initial determination) Click Here

Redetermination 2nd Level Appeal (used if 1st level appeal is denied. Must be submitted with 180 days from the date of receipt of the redetermination (level 1) decision) Click Here

Redetermination Status Click Here

We’re Here For You

We are here to support you and your needs and will keep you informed of new developments in this evolving situation.

Have more questions about reimbursement? Contact us!

Reimbursement Hotline: (866) 554-3751 Option 4 (toll free)  Email: reimbursement@cardiacinsightinc.com   
Hours of operation: 9 am–6 pm EST Telephone and email inquiries will be answered within 24 hours.

1Proposed Rule: https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-p
Folder: CY 2021 PFS Proposed Rule Addenda (ZIP) | Addendum B – Relative Value Units and Related Information CY 2021 CMS 1734-P
Final Rule: https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-f
Folder: CY 2021 PFS Final Rule Addenda Updated 12/29/20 (ZIP) | Addendum B – Relative Value Units and Related Information CY 2021 CMS 1734-F

2Hauser, Robert G., ND, GACC, FHRS. Cost-Effective Ambulatory ECG Monitoring. EP Lab Digest. May 2020