The 2025 CPT codes have a disappointing effect on insurance coverage for patients receiving thyroid nodule radiofrequency ablation (RFA).
In January 2024, the American Medical Association (AMA) RVS Update Committee (RUC) evaluated two new reporting codes for valuation: 60660 for percutaneous radiofrequency ablation of thyroid nodules and 60661 as an add-on code for additional nodule(s). The Centers for Medicare & Medicaid Services (CMS) suggested adopting the RUC’s recommended values in the proposed CY 2025 Medicare Physician Fee Schedule (MPFS).
Here are the key changes:
New CPT Codes: Two new codes have been introduced specific to radiofrequency ablation techniques for thyroid nodules. The second code is reported only when additional lobes are treated.
CPT code 60660 covers the ablation of one or more thyroid nodules in a single lobe or the isthmus, including imaging guidance.
CPT code 60661 is an add-on code for the ablation of additional nodules in another lobe, including imaging guidance, radiofrequency.
Valuation and Reimbursement:
The Centers for Medicare & Medicaid Services (CMS) have accepted the recommended work Relative Value Units (RVUs) for these codes. This means that the reimbursement rates for these procedures have been updated to reflect their complexity and resource requirements.
Single Use Limitation:
CMS has directed that these codes be used only once per treatment session, regardless of the number of nodules treated in each lobe. This is different from previous codes for biopsy procedures, which allow separate reporting for each lesion.
Impact on Billing Procedure:
These changes aim to streamline the coding and billing process, ensuring that patients receive appropriate reimbursement for their treatments. The new codes are intended to standardize the reporting of thyroid nodule RFA procedures, making it easier for healthcare providers to document and bill for these services accurately.
Impact on Insurance Coverage
Over the last 5 years, numerous patients have been anticipating the development of this code to seek treatment with insurance coverage benefits. Regrettably, the new code has established reimbursement rates too low for RFA to remain financially viable in an outpatient clinic setting.
Overall, the new CPT codes are designed to improve the accuracy and efficiency of billing for thyroid nodule RFA procedures. Ultimately this has negligible benefit to patients who will be required to supplement their insurance coverage in order to receive desirable, non-surgical alternatives to treat thyroid nodules and to preserve their thyroid functioning without requiring medication for the rest of their lives.
Although the assignment of specific CPT® codes represents acceptance of thyroid RFA as a standard medical procedure, it does so without awarding sufficient insurance coverage to significantly increase its adoption.
Read more:
Comments