Approved codes* for Viadur®
	Drug	Code	2007 average allowable‡
	CPT® code for insertion	11981	$115.53
	CPT code for removal	11982	$134.59
	CPT code for removal with insertion	11983	$200.68

	CPT codes for follow-up visits*
	Code	Physician presence required	Typical length of visit	Problem presented	Requires 2 out of 3 of the following	2007 Medicare Average Allowable
	99211	No	5 min.	Minimal		$20.09
	99212†	Yes	10 min.	Self-limited or minor	—A problem focused history —A problem focused examination —Straightforward medical decision making	$36.76
	99213†	Yes	15 min.	Low to moderate	—An examination problem focused history —An expended problem focused examination —Medical decision making of low complexity	$59.50
	99214†	Yes	25 min.	Moderate to severe	—A detailed history —A detailed examination —Medical decision making of moderate complexity	$90.20
	99215†	Yes	40 min.	Moderate to severe	—A comprehensive history —A comprehensive examination —Medical decision making of high complexity	$122.03

• Counseling provided to patients at the time of implantation,
  reimplantation, or during follow-up visits may also be
  reimbursable using the appropriate CPT code*
• Follow-up appointments should be scheduled at your discretion
  for regular examinations and to monitor your patients’ PSA

CPT is a registered trademark of the American Medical Association.

‡Average allowables as posted by CMS for the 1st quarter, January 1 - March 31, 2007. For more information visit www.cms.hhs.gov

*According to the American Medical Association’s Current Procedural Terminology 2004, a provider may bill Medicare for an office visit on the same day as a Viadur implant only if the decision to treat the patient with Viadur occurred during the office visit. When billing for an office visit on the same day as a Viadur implant, the office must attach a –25 modifier to the office visit. The –25 modifier indicates a significant, separate identifiable evaluation and management service (e.g., office visit) was performed by the same physician on the same day of a procedure and documented in the record. Because the office visit CPT codes vary based on time, complexity, and other factors, the provider will determine the appropriate office visit code based upon the content of the service provided.

†Counseling at the 99212 level or above requires that at least 2 out of 3 criteria for that level be met. See complete guidelines for process description.

For more details about Viadur^® reimbursement, call 1-877-4VIADUR
Monday through Friday, 9:00 am to 5:00 pm EST

* Medicare Chart Book 3rd Edition Summer 2005 Section 3 page 22