Medicare's new AI experiment sparks alarm among doctors, lawmakers

[Silent Type]

22. Absolutly incorrect. Original Medicare has extensive coverage policies. No, the patient won't pay because it'll be

denied if it doesn't meet requirements (docs can appeal), then the patient can decide whether to get the non-covered procedure/service.

It's very appropriate. There are no services on the list that are "life or death." And everyone of them has a Medicare coverage policy, either National (NCD) or Local (LCD which could be as many as 10 states with other states following policy).

A total of 17 types of procedures will now need prior approval. These services are often flagged for being overused or not always medically necessary. Here's what’s on the list:

Electrical Nerve Stimulators (NCD 160.7)
Sacral Nerve Stimulation for Urinary Incontinence (NCD 230.18)
Phrenic Nerve Stimulator (NCD 160.19)
Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease (NCD 160.24)
Vagus Nerve Stimulation (NCD 160.18)
Induced Lesions of Nerve Tracts (NCD 160.1)
Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (LCDs L38307, L38312, L38385)
Epidural Steroid Injections for Pain Management (excluding facet-joint injections) (LCDs L39015, L39242, L36920)
Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (LCDs L34106, L38201, L35130)
Cervical Fusion (LCDs L39741, L39762, L39793)
Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee (NCD 150.9)
Incontinence Control Devices (NCD 230.10)
Diagnosis and Treatment of Impotence (NCD 230.4)
Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13)
Skin and Tissue Substitutes (general category)
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (LCD L35041)
Wound Application of Cellular and/or Tissue-Based Products (CTPs), Lower Extremities (LCD L36690)

Look up everyone of those and see how many fraud or abusive billing practices have been filed for the services. I have no problem punishing docs who cheat Medicare and patients with questionable treatments.