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The ReBuilder is Reimbursable by Your Carrier.

The ReBuilder qualifies fully for reimbursement under the code E0720.  

For Medicare- see below

ReBuilder 2407 Treatment SystemIn our ongoing efforts to keep the cost down for the ReBuilder, we do not provide staffing to enable us to interact with insurance companies on your behalf.  (We do sometimes provide them with needed codes if they call us.)  We cannot represent you with your insurance company directly because of the excessive time and record keeping expense that would have to be averaged into the unit's price.

The ReBuilder is fully registered with the FDA as both a TENS device(E0720) (for pain) and separately, as an EMS (E0745) for muscle atrophy with intact nerve.  Most insurance companies recognize, understand, and prefer the TENS description.

[Although the FDA calls the ReBuilder a TENS device because of their limited number of classifications, the function of the ReBuilder is exactly the opposite of a common TENS device.  TENS is meant to close nerve channels, while the ReBuilder is designed to open nerve channels.]

Blue Cross, Blue Shield, and other private plans:  

You will not need a prescription to purchase your ReBuilder, but you will need a prescription to provide to your insurance company as part of your claim.  Most people purchase their ReBuilder, use it for 30-60 days successfully, and then ask their physician for a prescription and a letter of medical necessity.  The format and codes your physician will need for forms are as follows...

Diagnosis:   "chronic intractable pain"     (DX Code: 338.4)

 Prescription:   DME Code E0720. FDA description is TENS.   ReBuilder, brand specific for pain. (no generic substitutions)

Medical Necessity:  "This device is medically necessary for the treatment of intractable pain unresponsive to drug, surgery, and/or physical therapy.  Patient has responded well to this treatment."

ReBuilder treatments in a clinic and product re-imbursement for home use are routinely covered by most insurance companies and Medicare under the codes used for electrical stimulation.

If your physician prescribes a ReBuilder for you, he will write a prescription, submit a medical necessity form, and most commercial insurance companies will reimburse according to the terms of your unique policy, usually 50-90% of the purchase price.

To reiterate:

Step 1) Buy the Rebuilder, share it with your physician.

Step 2) use the Rebuilder according to detailed instructions provided for 2-4 weeks, sharing with your doctor any positive results.  (evaluation form here)

Step 3) Your doctor prepares a claim for you, using the codes above.

Step 4) You or your doctor turn in your claim to your provider.

Step 5) You or your doctor follows up with your provider until you get re-imbursed. *

* Your reimbursement dollar amount varies from plan to plan... call your provider to see how much is covered for a "TENS device". (DME Code E0720)

click here for a printable version of this

Medicare policy:  

Recent developments with Medicare has caused a ruckus!  Until recently, Medicare was covering the Rebuilder, no matter where it was purchased. (like the providers above) New regulations now dictate that for Medicare re-imbursement, all purchases must be made through a registered Medicare supplier, also known as a DME (Durable Medical Equipment Supplier).

The manufacturer (Rebuilder Medical Technologies) is scrambling once again to get their new DME numbers.  Once this occurs, all Medicare people will be able to get the Rebuilder covered.  As of RIGHT NOW, this has not finalized. Instructions and all paperwork needed will be posted online as soon as it becomes available.

(NOTE: Medicare will only sometimes reimburse you with a direct re-imbursement on a first time reimbursement request for equipment.  We've heard several different things from various clients. Call your Medicare agent and ask if you still qualify for this "first time reimbursement request". If you do, then you can buy the Rebuilder now and get reimbursed in 30-60 days generally. If you do not qualify for this first time reimbursement request, then please see the Medicare procedure below.)

NOTE:  The Rebuilder Medicare kit retails for around $1400, plus at least 2 doctor visits. In many cases, your deductible portion would be just about what you can buy it for here directly, and you save all the Medicare hassle.  (Examples: if your deductible is 50%, then you'd still pay $700, plus 2 doctor visits.  If it's 40%, you still pay $560) 

Because we sell direct to the consumer, bypassing the middleman and insurance companies, you can save 50% - 60% off "retail" here.  If you do buy direct from us at the discounted price, you will not be able get reimbursed by Medicare.

Medicare and the Rebuilder

Here are two ways you can purchase a ReBuilder and get Medicare reimbursement:

  1. A physician that bills for Durable Medical Equipment (DME): for example a Podiatrist (foot doctor) that sells shoes and can bill DME with the code prefix "E". You can ask your podiatrist if he can do this.
     
  2. A pharmacy or medical supply store that sells and bills Medicare for Durable Medical Equipment (DME), for example wheel chairs and TENS devices.

Therefore, to get your ReBuilder, you need to do one of the following:

  1. Go to a physician that can prescribe the ReBuilder AND bills Medicare, or
     
  2. Locate a physician that will write a prescription for the ReBuilder and take that prescription to a participating DME pharmacy. The pharmacy will guide you through the next steps with your physician.

Either way, you will have to have a minimum of 2 office visits:

1. One to be evaluated for chronic pain for at least 3 months (that does not respond to other therapies) and to be given a ReBuilder and Conductive Garment Silver Socks to take home and use for one month. Your physician will write a prescription.

2. A second office visit, one month later, to verify that your are responding to the ReBuilder, and for him to fill out a "Medical Necessity Form". If he bills Medicare directly, he will do that for you, if not, then you need to take the Medical Necessity form back to your medical supply store and they will complete the billing process.

 

How to Write Your Prescription for Medicare

It is important that your prescription contain the information Medicare requires in order to get the coverage you need.  The prescription needs to include the following billing codes:
  • ReBuilder Model Number: 
    • The ReBuilder Model # 300 (Brand Specific) (E0720 TENS), or
    • The ReBuilder Model # 2407 (Brand Specific) (E0720 TENS)
     

  • Garments Required:

    • 1 Brand Specific ReBuilder Conductive Garment Model SS100 - Left Sock (NUKXLT - E0731), and

    • 1 Brand Specific ReBuilder Conductive Garment Model SS100 - Right Sock (NUKXRT - E0731)

     
  • Diagnosis Code:  (2 most common used)
    • Chronic Pain for 3 months.    DX Code: 338.4, or
    • Other Chronic Pain                DX Code: 338.29 
    • Unspecified Idiopathic Peripheral Neuropathy    DX Code 356.9

     

  •    Office Visit:
    • New patient 99204
    • Established Patient 99214

 

If the above information is not included as written above, it may either take longer to receive your ReBuilder or Medicare may deny reimbursement.

click here for a printable version of this

Questions

 

I don’t know if my pharmacy is a participating DME pharmacy or not, how do I find out?
If you do not know of a Medicare participating DME pharmacy, you can click the link below to locate one:

www.medicare.gov/Supplier/

  1. The above link takes you to the Medicare web site page titled “Medicare Supplier Directory” that is sub-titled  “Welcome to Supplier Directory” where you are asked to type in your zip code and click on “submit”.
     
  2. The next page is sub-titled “Search for a Supplier in ZIP Code" xxxxx (the zip code you entered).   On this page you will click the box in the left column that says “Durable Medical Equipment”, and then click “View Results”.
     
  3. The next page is titled “Results for Your Selected Product Categories”.  Explanations are given followed by a list of supplier names and addresses. 

 

If I have Original Medicare, how do I get the durable medical equipment I need?

  • If you need durable medical equipment in your home, your doctor or treating practitioner (such as a nurse practitioner, physician assistant, or clinical nurse specialist) must prescribe the type of equipment you need.
  • For some equipment, Medicare also requires your doctor or one of the doctor’s office staff to fill out a special form and send it to Medicare to get approval for the equipment. This is called a Certificate of Medical Necessity.
  • Your supplier will work with your doctor to see that all required information is submitted to Medicare. If your prescription and/or condition changes, your doctor must complete and submit a new, updated certificate.

What if I need durable medical equipment and I am in a Medicare Advantage Plan?

  • Medicare Advantage Plans (like an HMO or PPO) must cover the same items and services as Original Medicare.
  • Call your plan to find out how much you will have to pay.

How do I buy my ReBuilder through the participating DME pharmacy?

  1. Take your prescription to the pharmacy. 
     
  2. If the pharmacy does not have ReBuilders in stock (none currently do), then have them contact us at 951-303-3471 to place your order. 
     
  3. Return to your physician for a progress / follow-up visit thirty (30) days after getting the ReBuilder so the physician can document the medical benefit of you having the ReBuilder.  Your physician will give you a Certificate of Medical Necessity to take to your pharmacy.
     
  4. Take the Certificate of Medical Necessity to your pharmacy and they will complete the Medicare billing process.

 

Summary
To get your ReBuilder, you will do the following:

  1. Go to your physician that can prescribe the ReBuilder and bill Medicare, or
     
  2. Locate a physician that will write a prescription for the ReBuilder, and then you take that prescription to a participating DME pharmacy; the pharmacy will guide you through the steps with your physician.

 

 

 

 

Statements about neuropathy and others topics are for information only and should not in any way be used as a substitute for the advice of a physician.  Statements about neuropathy and the ReBuilder have not been reviewed by the FDA. Suggestions and ideas presented here should not be interpreted as medical advice, meant for diagnosing illness, or for prescriptive purposes.  The ReBuilder system’s electrical stimulation has been proven 95% effective in recent clinical studies in reducing and even reversing the symptoms of peripheral neuropathy.