Bio Lab Flow Fluid CPT Q4206 Test Results Interventional Pain Management
The purpose of this document is to detail our experience on three patients with stem cell Flow Fluid at our interventional pain management practice in Miami Florida.
At the time of this writing, May 20, 2002 one flow fluid was FDA approved and approved for payment by Medicare.
We injected a total of five patients, including the owner and primary pain management physician in our group. Our doctor decided to have himself injected first because this is a brand-new medication which had not been utilized by our practice in the past. The doctor is a 63-year-old Hispanic male and on wen May 3, 2021 went ahead with injections in his left knee, right knee and right shoulder. For our example we will call our Dr. patient #1.
The second patient(patient #2) was a disabled 61-year-old Hispanic male. After receiving consent we went ahead and injected his left knee with 1 cc of Bio Lab Flow Fluid.
The third patient(P3) was a 67-year-old Caucasian male. After consent we injected his right knee with 1 cc of Bio Lab Flow Fluid May 12, 2021. A follow-up procedure of 1 cc was performed on May 19,2021.
The fourth patient(P4) was a 67-year-old African-American female. After consent we went ahead on June16, 2021 and injected her right knee with 1 cc Bio Lab Flow Fluid.
The fifth patient(P5) was a 72-year-old Hispanic female. On June 16, 2021, After consent we injected her left knee with 1 cc Bio Lab Flow Fluid.
In each case we billed CPT code Q 4206 and 99213.
Bio Lab charged $2000 per cc for the Flow Fluid.
Our Dr., patient #1 did not bill insurance for his procedures.
Patient number #2 and patient #3 both were billed paid by Medicare.
All five patients including the doctor himself tolerated the procedure and the medicine well.
Despite all of the above a major problem developed. NONE OF OUR PATIENTS, received any relief from pain. Understandably our Dr. immediately began to question the “cost versus benefit” of the Bio Lab Flow Fluid and we reached the following conclusions.
1. The Bio Lab Flow Fluid at $2000 per cc is prohibitively expensive.
2. None of our patients including the doctor himself received any relief from pain.
3. The doctor concluded there was a substantial risk due to the prohibitively high expense of the medicine for denials and/or other nonpayment from Medicare which would render the medicine as more of a liability rather than a profit center for the practice.
4. Our Dr. believed that the extreme cost of this medicine used in a higher volume would open the practice up to future Medicare audits.
5. Here’s where the story gets interesting. The most concerning portion for the practice was the fact that none of the patients received any relief from pain. The professional component of the procedure itself yielded less than $100 from Medicare and at $2000 per 1 cc cost of the medicine yielded this an extremely risky procedure. To counteract the low profitability and the point at which our Dr. became very suspicious and concerned was the fact that Bio Lab offered a 40% rebate on the medicine at the end of each calendar month depending on usage.
On July 1, 2001
our Dr. asked me to contact Biotech Laboratory personally to question their recommendation that we place the invoice price of the medicine in the equivalent of block 19 on the HCFA 1500 claim form. I advised biotech laboratory that our Dr. was not about to list an invoice price that we paid for a medicine where ultimately and in reality we paid 40% less because of the rebate. This seemed extremely unethical to our Dr. and myself. Consequently, we decided to discontinue using Bio Lab flow fluid and returned the remaining portion of the medicine.
- Bio Lab Flow Fluid CPT Q4206 Test Results Interventional Pain Management
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