Reimbursement

SpaceOAR® hydrogel was FDA-cleared in April, 2015 and is intended to temporarily position the anterior rectal wall away from the prostate during radiotherapy for prostate cancer.  In creating this space, it is the intent of SpaceOAR hydrogel to reduce the radiation dose delivered to the anterior rectum. The SpaceOAR Hydrogel is composed of biodegradable material and maintains space for the entire course of prostate radiotherapy treatment and is completely absorbed by the patient’s body over time. FDA Clearance Letter

Effective January 1, 2018, the new Category I CPT Code for SpaceOAR is 55874 under descriptor: Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed. 2018 SpaceOAR Coding and Payment Quick Reference Guide

Health insurance providers may require additional information to help them understand the procedure and technology.

Augmenix has a team of Field Reimbursement Managers and offers assistance to health care providers and their facilities in their efforts to educate payers and navigate through the reimbursement process.

For questions regarding SpaceOAR:

  • General Reimbursement Information
  • Prior Authorization Assistance
  • Claims Appeal Assistance

Contact us:

We Can Help You Navigate Through the Reimbursement Process

Check out Our Provider Support Resources

Disclaimer: It is always the provider’s responsibility to determine and report the appropriate procedure and supply codes based upon medical necessity and procedures and supplies provided to the patient. Coding and reimbursement information is provided for educational purposes and does not assure coverage of the specific item or service in a given case. Contact your local Medicare Administrator Contractor (MAC) or CMS for specific information as payment rates listed are subject to change. To the extent that you submit cost information to Medicare, Medicaid or any other reimbursement program to support claims for services or items, you are obligated to accurately report the actual price paid for such items, including any subsequent adjustments. CPT® five-digit numeric codes, descriptions, and numeric modifiers only are Copyright AMA. All rights reserved.