Under some managed care contracts, the costs for all implantable devices are payable in addition to the regular contractual allowances. These “carve outs” or “pass-thru charges” must be correctly billed to receive the entitled payments.

The implants could be inserted in the surgery department, the ambulatory surgery suite, the cardiac catheterization lab, interventional radiology, the Endoscopy department, the urology clinic, electrophysiology or the eye clinic.

Some managed care contracts require the provider to include a copy of the purchase invoice with the bill for each implantable device. Other contracts require that the implantable device be billed using a specific revenue code at a fixed markup above cost. Either way, implants will not be reimbursed unless the specific billing requirements are met.

With such a large variety of implantable devices being utilized in diverse locations throughout the hospital, it is very difficult to insure that every one is properly billed.