Reimbursement support

for i-FACTOR Peptide Enhanced Bone Graft

Cerapedics, Inc. has partnered with MCRA, LLC to provide dedicated reimbursement support for i-FACTOR Peptide Enhanced Bone Graft™. The CODING HOTLINE and PATIENT COVERAGE ACCESS services utilize credentialed coders to provide live responses to your questions. You’ll also receive a Billing Guide and Comprehensive Reimbursement Resource Guide that covers the following topics and more.

i-FACTOR Bone Graft Technology

i-FACTOR Bone Graft is indicated for use in skeletally mature patients for reconstruction of a degenerated cervical disc at one level from C3-C4 to C6-C7 following single level discectomy.

Coding Basics

Overview of coding for new or existing procedures or technologies, the different coding and reimbursement pathways and types of code sets.

Coding pathway options by place of service

Coding pathway information is intended for provider guidance and allows the physician to consider his or her reporting pathways on a case by case basis.

Indications and contraindications check list

On label checklist to help you in the patient selection process.

Pre-authorization overview

Some health plans require preauthorization for all surgical procedures. Requesting pre-authorization may only involve a simple contact by the physician’s office to verify benefits and acquire an approval number to submit with the claim.

Plan denial appeal process overview

When a third party health plan denies a procedure in accordance with its medical policy guidelines, there is a process available to appeal that decision.

Resources for technology support

These resources can provide support when coding and preparing a pre-authorization for spinal fusion procedures when performed in the inpatient, outpatient or surgery center setting of care.

Supportive literature

These resources can provide support when coding and preparing a pre-authorization for spinal fusion procedures when performed in the inpatient, outpatient or surgery center setting of care.

Frequently asked questions

Who can I contact for additional reimbursement questions and support services?

Contact the Cerapedics Reimbursement Support Program at 800-361-0795 or Cerapedics@MCRA.com

What CPT code can be reported when i-FACTOR is used in ACDF procedure?

CPT 20930 is described as “Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)” per the official AMA/CPT codebook.

What CPT code can be reported when an allograft ring is used in ACDF procedure?

CPT 20931 is described as “Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)” per the official AMA/CPT codebook. CPT is a trademark of the AMA.

What CPT code can be reported for a traditional ACDF (anterior cervical disectomy and fusion) procedure?

CPT 22551 is described as “Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2” per the official AMA/CPT codebook. CPT is a trademark of the AMA.

What are some of the HCPCS code options available for an ACDF procedure and the use of i-FACTOR

HCPCS code assignment is dependent on many factors and is determined by the provider and the specific Health Plan guidelines. Some possible options include the following:

HCPCS Coding Pathway Options

HCPCS Code HCPCS Code Description

C1713    Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)

L8699    Prosthetic implant, not otherwise specified

C9399    Unclassified drugs or biologicals

C1889    Implantable/insertable device for device intensive procedure, not otherwise classified


₁ 2018 HCPCS, www.cms.gov

What are NCCI edits?

The National Correct Coding Initiative (NCCI) was implemented by Medicare to provide code pair edits to prevent improper payment when certain codes are submitted together for Medicare Part-B services. This information can be accessed on the CMS website at NCCI Edits.

Many Health Plans require pre-authorization for spinal procedures. Are there general guidelines for how long this process can take?

Each insurance company, each plan and each specific case will have a defined process and timeline based on carrier guidelines and state regulations for pre-authorization of a spine procedure such as ACDF if required. It is very important to review and following the individual guidelines that are applicable to the case. The following summary gives an overview of the possible timelines for pre-authorization and pre-authorization denial appeals. This is only a generalized example and does not represent any specific insurance plan guidelines.

Pre-Authorization Process Generalized Overview Estimated Time Frames
Initial Pre-Authorization 1-15 Days
Peer to Peer Reconsideration 1-3 Days
1st Level Appeal 3-30 Days
2nd Level Appeal 3-30 days
External Appeal (IRO) 5-45 Days
Can an ACDF procedure be performed in the Ambulatory Surgery Center (ASC) setting of care?

Medicare and many commercial insurers now allow this procedure to be performed in the ASC. Specific Health Plan and carrier guidelines should always be followed when determining the appropriate setting of care for any procedure.