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Volume 4; Issue 5
|Dear Ronald Sherman,
The BTER Foundation has just issued the following press release, which also can be found at: www.bterfoundation.org/indexfiles/BTER%20Foundation_PR_0811.pdf
you can see below, we are very pleased to announce that the American
Medical Association (AMA) and the Centers for Medicare and Medicaid
Services (CMS) took our concerns about maggot therapy coding seriously,
and issued coding recommendations that should support your requests for
We are grateful for their efforts to
work together in this way to improve patient services and clinician
compensation. Their action demonstrates their support for all of us
that use or receive biotherapy.
Thank you all who wrote letters for us to take to the CMS Public Hearing in Baltimore, back in April, 2008. The words of
Margaret Mead (which appear at the bottom of most of our newsletters), ring true, again: "Never
doubt that a small group of thoughtful, committed people can change the world.
Indeed, it is the only thing that ever has."
|Press Release, November 10,
Medicare Coding for Maggots & Maggot Therapy
Today, the BioTherapeutics,
Education & Research (BTER) Foundation was notified that the American
Medical Association (AMA), in collaboration with the Centers for Medicare and
Medicaid Services (CMS) have just issued reimbursement coding guidelines for medicinal
maggots and maggot therapy.
Appearing in the September,
2008 edition of CPT® Assistant (Vol 18, Issue 9, page 11), the coding advisors wrote:
". . . . [CPT®
code] 97602 may be [used to report maggot therapy], as it is a type of
nonexcisional debridement. To further clarify, the Centers for Medicare and
Medicaid Services Transmittal 5, dated November 19, 2004, included maggot
therapy as a type of debridement . . . . The supply of maggots should be
reported in addition to the wound management code 97602 with CPT®
supply code 99070, Supplies and materials (except spectacles), provided by the
physician over and above those usually included with the office visit or other
services rendered (list drugs, trays, supplies or materials provided)."
Earlier this year, the BTER
Foundation formally requested that the AMA and CMS provide better guidance or
specific codes to improve medical record documentation of maggot therapy and
requests for reimbursement. In April, BTER Foundation Board Members Ronald
Sherman of Irvine, California,
and Pamela Mitchell from Akron, Ohio, were invited to appear at a public hearing at
headquarters. They brought with them dozens of letters from maggot therapists
and patients frustrated by their difficulties getting reimbursed by insurance
companies and Medicare subcontractors for their maggot therapy expenses. Medicare
officials were quite sympathetic to the requests for better coding and
processing of insurance claims for maggot therapy, explaining that product
coding and reimbursement needed to be coordinated with procedural coding and
In a letter received today
by Dr. Sherman, Director of the BTER Foundation and Laboratory Director for
Monarch Labs (producer of Medical Maggots™ brand of medicinal
maggots), CMS officials announced their collaborative work with AMA, and the
publication of their coding recommendations in CPT® Assistant.
The letter and published
coding advice were enthusiastically received by BTER Foundation members, as
they will be by the entire wound care community. Not only do the coding
recommendations reaffirm that maggot therapy is accepted by two of the most respected
health care authorities in the nation, but these actions also demonstrate the continued
commitment of AMA and CMS to patients and therapists who use medical grade
maggots in wound care.
Maggot therapy is the use
of specially prepared fly larvae for treating chronic wounds. Medical
Maggots™ brand of medicinal maggots were granted marketing clearance by
the FDA in 2004 for treating neuropathic (i.e., diabetic) foot ulcers, pressure
ulcers ("bed sores"), venous stasis ulcers, and traumatic and post-surgical
wounds failing other forms of conventional therapy. There are now over 1,000
therapists using maggot therapy in the U.S.
A treatment supply of medicinal maggots costs less
than $100, but reportedly can save thousands or even tens of thousands of
dollars in medical, surgical and hospital costs. "It's strange, but many
insurance companies will pay tens of thousands of dollars for an amputation,
probably because it is so common now-a-days, but will hesitate or object to
paying $100 for a course of maggot therapy," said Dr. Sherman, "even though
studies repeatedly demonstrate that medicinal maggots have saved 40-50% of
limbs otherwise scheduled for amputation due to non-healing wounds." It's no
wonder that more and more patients are demanding that their doctors try maggot
therapy, even when patients are asked to pay for the treatments themselves.
Dr. Sherman added: "The
timing of this recommendation, just before Veteran's Day, does not go
unnoticed. The beneficial effects of maggots in wounds saved thousands of
soldiers through the centuries, and it was a World War I surgeon, William Baer,
who first developed the techniques of maggot therapy while at John Hopkins
University." Dr. Sherman's own clinical studies ere performed during the 1990's
at the Veterans Affairs
in Long Beach, California, with funding from the Paralyzed
Veterans of America.
The BTER Foundation,
established in 2003, is a not-for-profit organization dedicated to supporting
patients, educating health care providers and furthering research in biotherapy
such as maggot therapy, leech therapy, cancer-detecting and service dogs, and
the use of other living animals to diagnose or treat illness. Supported
primarily by donations and users of its educational materials, the BTER
Foundation has been providing Patient Assistance Grants for over 5 years,
helping families without adequate health insurance or personal financial
resources to pay for medicinal maggots and other medicinal animals.
Therapists are reminded
that insurance reimbursement requires not only correct coding but also
appropriate use of resources and thorough documentation.
Courses & Meetings
|BTER Foundation Workshops and Exhibits
Conferences with BioTherapy Lectures & Posters
Diabetic Limb Salvage; September 18-20; Washington, D.C.
Wild on Wounds; September 18-20; Orlando, FL
American Association of Equine Practitioners; December 6-10; San Diego, CA
How about a Workshop in Your Town?
arrange a maggot therapy or leech therapy workshop in your community,
contact the BTER Foundation. Local and national experts are available
to provide 1-hour lectures, full day workshops, and anything in between.
|Do You GoodSearch?
| Everytime you search the internet, you could be generating funds for the BTER Foundation.
|Thank you for your continued support of the BTER Foundation. Let us know how we can help you.
Ronald Sherman, Director
BioTherapeutics, Education & Research Foundation
THE BeTER LeTTER is published by:
BioTherapeutics, Education & Research (BTER) Foundation
36 Urey Court, Irvine, CA 92617
Phone: 949-509-0989 / Fax: 949-509-7040
editor@BTERFoundation.org / www.BTERFoundation.org
Ronald A. Sherman
Ben-Yakir, Jose Contreras-Ruiz, Robert McKie, Jacques Oskam, Pascal
Steenvoorde, Tarek Tantawi, Catalina Wang, Shou Yu Wang
Eve Iversen, Joanne Preston, Alison Shorger
Board of Directors
Ronald A Sherman (Chair); Randall Sullivan (Secretary);
Samuel G Kohn (Treasurer); Sharon Mendez, RN, CWS;
and Pam Mitchell (Patient Advocate)