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How To Get Reimbursed from Insurance Companies and Medicare.

We do not submit insurance claims for customers. We tried that, but the added administrative cost adds $100 to the cost to the customer, so we are no longer representing the customer with insurance companies or Medicare. We even registered as a Medicare provider, but the hassle the ensued was enormous so we dropped the registration.  

Medicare Policy: The manufacturer (Rebuilder Medical Technologies) is now handling ALL Medicare people and deals with Medicare on your behalf.  Contact Rebuilder Medical directly for Medicare procedure. 304-725-2202

For ALL Other Providers:

Most major private plans and Blue Cross/Blue Shield will pay 80% of cost in a single payment with a prescription.  (Your plan may vary.) 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 for re-imbursement. Most people purchase their ReBuilder, use it for 30-60 days to successfully (symptoms begin to improve), and then ask their physician for a prescription.

In general, to get re-imbursed you'll need 3 things:  A Letter of Medical Necessity from your doctor, a Prescription from your doctor, and a patient history of failed alternatives such as pain meds, therapy, etc...  

The ReBuilder has two separate FDA registrations: one as a TENS (Transcutaneous Electrical Nerve Stimulation) device for pain, and the other as an EMS device (Electro Muscle Stimulator) for “muscle atrophy with intact nerves”.  The best way to get coverage is to use the TENS description E0720 and write the prescription for pain, noting on the prescription that the physician requests "ReBuilder, Brand Specific" and the words "Medically Necessary". Even with these notes on the prescription, your provider may request that you use one of their own forms – ask your agent.

Side note: 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.)

For Your Doctor...

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

[Other Possible Diagnosis Codes: “Other Chronic Pain” (DX Code: 338.29),  “Unspecified Idiopathic Peripheral Neuropathy”  (DX Code 356.9)]

Prescription:  “ReBuilder, brand specific (no generic substitutions) for pain. DME code (also known as HCPCS number) is E0720. FDA description is TENS.”  (Most insurance companies recognize, understand and prefer the TENS description.)

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

To further support the need for a prescription, you may also include a product usage Clinical Evaluation of some sort.  Sample Evaluation Form Here:  www.peripheralneuropathytreatments.com/RebuilderEvaluationStudy.pdf  (Your doctor may have his own forms)   

Also as an alternative Diagnosis: "disuse muscle atrophy with intact nerve, unrelated to neurological deficits". (DX code 728.2)  DME code E0745 Neuromuscular Stimulator Electronic Shock Unit.  Note: This code may result in a denial labeled "experimental" so this code is not a good one to use.)

DME Codes (Durable Medical Equipment) >> Sometimes referred to as HCPCS Codes (Healthcare Common Procedure Coding System)  These are billing codes used by healthcare providers. Your doctor will know what these are.

E0730, TENS, Brand specific, ReBuilder Model #2407

E0720, TENS, Brand specific, ReBuilder Model #300

E0731 Conductive Garment (gloves and socks) for TENS or NMES (NeuroMuscular Electrical Stimulation) with conductive fibers separated from patient's skin by layers of fabric. And/or...  Area to be treated is too large for the normal electrodes.  And/or...  Patient cannot tolerate the adhesives of normal conductive electrodes.) 

E0745 Electro Muscle Stimulator for muscle atrophy with intact nerve.

A4558 Conductive Gel
A4595 TENS supplies, 2 adhesive pads per month
A4630 Batteries, TENS owned by patient
A4556 Electrodes
A4557 Lead wires.
 

CPT Codes: (Current Procedural Terminology)

CPT for attended electrical stimulation: 97032  (requires dozens of visits)
CPT for unattended electrical stimulation: 60283  (home use)
CPT for patient training: 64550 Chronic, intractable pain

 

If you need help, have your physician contact us. We will have our medical professionals contact him/her for a detailed explanation of the ReBuilder and how to prescribe it.

 

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ReBuilder® Model 2407
ReBuilder® Model 300