Medicare, Medicare Advantage and self-pay

What we accept

Medicare Part B

Enrolled and credentialed. Covers medically necessary in-home evaluation and joint injection services, subject to Medicare rules and your deductible and coinsurance.

UnitedHealthcare Medicare Advantage

Credentialed.

Network Health Medicare Advantage

Credentialed.

Humana Medicare Advantage

Credentialed.

iovera° cryoneurolysis

Self-pay only — $895 per treatment. Not billed to Medicare or Medicare Advantage. HSA and FSA funds can be used.

HSA and FSA payment

iovera° is an eligible expense for a Health Savings Account or a Flexible Spending Account. The IRS defines medical expenses as “the costs of diagnosis, cure, mitigation, treatment, or prevention of disease,” including “payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners” (IRS Publication 502). For HSA purposes those same rules apply — qualified medical expenses means amounts paid for medical care as defined in Internal Revenue Code section 213(d) (IRS Publication 969). iovera° is treatment of a diagnosed condition, delivered by a licensed physician assistant. It is not a wellness service or a cosmetic one.

What we give you for your records

Every self-pay patient receives an itemized paid receipt showing the date of service, the practice name and NPI, the clinician, the diagnosis code, the procedure code and the amount paid. That is the substantiation your plan administrator asks for, and it is what the IRS expects you to be able to produce (Publication 969 requires records sufficient to show that distributions were used exclusively for qualified medical expenses and were not reimbursed from another source).

If you are on Medicare

This is worth understanding clearly, because it catches people out. Once you enroll in Medicare you can no longer contribute to an HSA — but money already in the account stays yours, and you can still spend it on qualified medical expenses, including iovera°. Many of our patients have an HSA balance left over from their working years and did not realize they could still use it. An adult child or spouse may also be able to pay from their own HSA if you are their tax dependent, or from an FSA in the plan year the service was provided. Plan rules differ, so confirm with your administrator before you rely on it.

We are describing general IRS rules, not giving tax advice, and we cannot determine your eligibility for you. Your plan administrator and your tax advisor make that call. We simply make sure the paperwork is right.

How to pay

Self-pay balances are due at the time of treatment. We can take payment by HSA or FSA debit card, or by another method arranged on the screening call. If a family member is handling payment on your behalf, tell us on that call and we will set it up before the visit rather than sorting it out at your kitchen table.

Which treatment is billed how

Ultrasound-guided corticosteroid injection

Billed to Medicare Part B or your credentialed Medicare Advantage plan.

Hyaluronic acid (gel) injection

Billed to Medicare Part B or your credentialed Medicare Advantage plan. Plan rules for viscosupplementation vary by joint, so we verify first.

iovera° cryoneurolysis

Self-pay.

Pre-visit telephone screening

Free. No charge, no obligation.

If we are not in network with your plan

Say so on the screening call and we will tell you plainly what your options are, including a self-pay rate, rather than letting you find out from a statement weeks later. If another practice is a better fit for your coverage, we will say that too.

What we do not do

• We do not bill for the screening call.
• We do not add a travel or “house call” surcharge for covered services.
• We do not sell packages or require prepaid treatment plans.

Questions to have ready

• Your Medicare or Medicare Advantage card.
• Your current medication list.
• Any recent imaging reports for the joint, if you have them.
• The name of your primary care provider, and your surgeon if you have one.

Individual results vary. No treatment guarantees complete or permanent relief, and every plan starts with an examination and a conversation about your goals.