Selective Intrauterine Growth Restriction (siugr)

The Bundled Rate plus Outlier Per Diems includes:

1. Those comprehensive facility, professional, and anesthesia services, supplies, blood bank fees (incurred pre-procedure) and equipment necessary to perform the Bundled Procedure and rendered by provider; 2. For the treatment of any complication or concurrent illness associated with or resulting from the performance of the Bundled Procedure during the Bundled Rate Payment Period. 3. For single gestations, case rates include surgeon, two (2) consultations, two (2) ultrasounds, transvaginal ultrasound, and two (2) Doppler scans. 4. For multiple gestations, case rates include surgeon, two (2) consultations, four (4) ultrasounds, transvaginal ultrasound, and four (4) Doppler scans. 5. For endoscopic repair of spinal bifida, case rates include surgeon, six (6) consultations, six (6) ultrasounds, transvaginal ultrasounds, and six (6) Doppler scans. The Bundled Rate Period covers the 1 day(s) prior to the procedure for the scheduled Accarent Procedure and up to 1 inpatient days in the hospital. Should the length of stay exceed 1 inpatient days, then per diem outlier payments will be applicable for each subsequent inpatient day. Covered outpatient follow-up services related to the bundled procedure beginning on the day of discharge through 30 calendar days are included in the bundled price.

Candidacy for the bundled procedure will be determined by the Provider.