Medicare Coverage & Reimbursement
HIFU Treatment Near Los Angeles
Medicare Coverage of HIFU July 2017
Medicare covers the facility portion of a HIFU procedure. That means that all charges from a hospital or surgery center where your procedure will be performed are covered. Dr. Pugach is now contracted with a leading local hospital outpatient surgical center to treat Medicare patients with HIFU.
What services are covered by Medicare?
- In July 2017, a reimbursement code went into effect for HIFU for ablation of the prostate. This means that HIFU can be used to treat prostate cancer and benign prostate growth.
- The reimbursement code, called a c-code, is specifically for patients covered by Medicare and only applies to a hospital outpatient facility or Ambulatory Surgery Center (ASC).
What services are NOT covered by Medicare?
- Treating physician fees
- Anesthesiologist fees
- HIFU Prostate Services* (HPS ) concierge patient support services
- Other HIFU related expenses (see below)
If you have a Medicare Advantage plan (Medicare HMO) your plan may or may not cover the hospital or surgery center charges. Each plan is allowed to determine whether or not it will pay for this so prior authorization will be requested. There will be no charge to you for this determination service.
Other HIFU Related Expenses
Your initial prostate cancer office visit (consultation) with Dr. Robert Pugach may be covered by Medicare. We are happy to check your Medicare benefits without charge. Just call, 844.443.8362, so we can verify if your Medicare Plan will cover our consultation.
The cost of pre-HIFU medical clearance and any lab tests required by your anesthesiologist are not included in HIFU fees. We will outline all of this for you in detail so there are no unforeseen financial surprises. The cost of this testing is usually very nominal.
Additional Medical and Laboratory Information
We’re here to help you. Providing your clinical information to us facilitates that! While every patient’s medical information varies, there are certain items that help us determine if HIFU may be an appropriate treatment option for you. The most important medical information and laboratory tests you can provide are:
- Pathology report from your biopsy
- PSA results – actual lab slips going back as far as you can find them
- Copies of the ultrasound images that were made when you had your biopsy
- MRI report if you’ve had one done
- Bone scan results if you’ve had one done
- Copies of office records from your urologist
- Copies of reports from any consultants you’ve seen
*At Western States HIFU, we work closely with HIFU Prostate Services, LLC (the country’s most experienced HIFU provider) to streamline the entire process including payment processing. HPS has reimbursement specialists standing by to assist you without charge. Please call us to discuss financial arrangements and financing options.
If you are in the greater Los Angeles and Orange County area, or surrounding communities, we offer convenient appointments in our two private practice offices in Los Alamitos and Huntington Beach. We typically schedule appointments at the end of each day so you won’t feel rushed as we discuss your prostate cancer and treatment options.
**For patients who live in more distant areas of California, neighboring states, other parts of the U.S., or if you are an international patient, Dr. Robert Pugach offers online/virtual or telephone consultations in a time zone that is mutually convenient.**