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Approval of the Barricaid will vary by health plan requirements. Refer to the members’ contract benefits at the time of service to determine coverage or non-coverage of a Barricaid case.

Commercial

  • Commercial Payors are covering on a case-by-case basis.
  • The majority of Barricaid cases will require prior authorization.
  • Coverage and payment are determined post procedure after claim submission.

Medicare (CMS)

  • The majority of Barricaid cases will require prior authorization.
  • Medicare Advantage plans may revert to the parent plan commercial policy.
  • Without a written NCD or LCD, CMS permits Medicare Advantage Organizations (MAO) to define their own coverage determinations.

Medicare Advantage

  • Medicare Advantage plans may cover on a case-by-case basis.
  • The vast majority of Barricaid cases will require prior authorization.

Medicaid

  • Refer to the State Medicaid fee schedule for coverage and payment.
  • Prior authorization is required.
  • Payment will vary state by state.

Managed Medicaid

  • Managed Medicaid may or may not be required to follow state guidelines for coverage.
  • Prior authorization is required.
  • Payment may vary from State Medicaid plans

If you have any specific payor coverage questions, please contact the Patient Access Team at 844-288-7474 or email at reimbursement@barricaid.com

 

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Barricaid Reimbursement Support
 
The Patient Access Program can be reached at (844)-288-7474.
 
 
 
Disclaimer: This reimbursement information is provided by Intrinsic for informational purposes only. This is not an affirmative instruction as to which codes and modifiers to use for a particular service or item. Any coding, coverage, and payment information contained herein is gathered from various resources and is subject to change without notice. It is always the provider’s responsibility to determine. medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Intrinsic recommends that you consult with your payors, reimbursement specialists and/or legal counsel regarding coding, coverage, and reimbursement matters. Rates for services are effective January 1, 2021.