 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
Medicare
Billing
Innovate, Inc. is a distribution company that offers Medicare
approved products. This page outlines the Medical
necessity, HCPCS Codes, and Diagnostic Codes associated with
each product line. |
 |
 |
 |
 |
 |
 |
 |
|
|
|
Medicare Billing Process |
|
The process of selling,
delivering, training, billing, and collecting reimbursements for the
Cybertech Back Braces, Dr Zen Diabetic Shoes, and Encore ED Vacuum Devices follow a similar process as with most DME products. Below,
we take you through each of the steps along with estimates for billing and
reimbursements. |
|
Common Requirements |
|
All of these
products must meet some of the same criteria including:
- Medical Necessity qualification
- Eligibility and Medicare Part B or Insurance qualification
- Rx Signed by appropriate physician
- Delivery confirmation
- Documentation approval by patient
|
|
|
| |
|
Cybertech Back
Braces |
Certification & Training
For Medicare Provider
companies, the certification requirements vary from
state to state. It is recommended that
Medicare Providers who would like to provide back
braces, contact their Accreditation company to
determine the certification requirements. Innovate,
Inc. provides personalized telephone training,
resulting in a Training Certificate.
|
Who
Qualifies |
|
One of the following indications must be
met: ● To reduce pain by restricting mobility of the trunk; or ● To facilitate healing following an injury to the spine or
related soft tissues; or ● To facilitate healing following a surgical procedure on the
spine or related soft tissue; or ● To otherwise support weak spinal muscles and/or a deformed
spine. |
|
Diagnostic
Codes |
|
Diagnosis
|
Description |
|
724.2 724.0 728.87 756.12 722.10 721.3 847.2 724.9 722.52 |
Lumbago Spinal Stenosis Muscle Weakness Spondylolisthesis Lumbar Disc Displacement Lumbosacral Spondylosis Lumbar Strains/Sprain Spinal Disorder Lumbar/Lumbosacral Intervertebral Disc Degeneration |
Items
Qualified for |
|
If a patient
is qualified, they may receive the following items:
- The Rx sent to the Physician should
provide the options of different back braces. It is the
responsibility of the Dr. to determine the appropriate back brace for
their patient.
- 1 Cybertech Back Brace - Includes Brace &
Appropriate Panels (1
unit every 5 years)
|
|
Reimbursement Analysis |
|
|
|
Medicare |
Medicare |
Average |
Average |
Average |
|
|
|
Allowable |
Average |
Medicare |
Dealer |
Medicare |
|
Description |
HCPCS |
Range |
Allowable |
Reimb. |
Cost
|
Margin |
|
|
|
|
|
|
|
|
|
Spine Brace
Flex Power Plus w/Panels |
L0627 |
$333 - $443 |
$388 |
$310 |
$105
|
$205
|
|
|
|
|
|
|
|
|
|
Premium Plus
w/Panels |
L0631 |
$831 - $1,107 |
$969 |
$775 |
$210
|
$565
|
|
|
|
|
|
|
|
|
|
Tri-Mod
w/Frame & Panel |
L0637 |
$949 - $1,266 |
$1,107 |
$886 |
$210
|
$676
|
|
|
| |
|
|
Dr Zen Diabetic
Shoes |
Certification & Training
There are specific
Medicare education and certification
qualifications required to provide diabetic
shoes. In most of the states the only
requirement is to have a Manufacturers
Certificate. Innovate, Inc. sells a Fitter
Training course that results in a Dr Zen
Manufacturer Certificate. The other states
(FL, AR, OH, IL, OK, TX, etc) may require the
fitter to be a Pedorthist - these states will
not accept a Manufacturers certificate. If
you are considering providing shoes, contact
your Accreditation company to determine the
certification requirements.
Manufacturer Certificate
Innovate, Inc.
offers a Self-study Fitter Training course that
can be sent via Email along with a short test.
The entire program takes less than 6 hours to
complete. Upon successful submission of
the test, a Dr Zen Manufacturers Certificate
will be issued that can be used for those states
that will accept it. Call your
Accreditation company to determine if the
manufacturer certificate will satisfy your State
requirement. |
Who
Qualifies |
|
The following criteria must be met: ● The patient has diabetes mellitus (ICD-9
diagnosis codes 250.00-250.93), is eligible for
Medicare benefits; and
The patient has one of the
following conditions: ●
Previous
amputation of the other foot, or part of either foot, or ●
History
of previous foot ulceration of either foot,, or ●
Previous
amputation of the other foot, or part of either foot, or
●
History
of pre-ulcerative calluses of either foot, or
●
Peripheral neuropathy with evidence of callus
formation of either foot or
●
Foot
deformity of either foot or
●
Poor circulation in either
foot |
|
Diagnostic
Codes |
|
Diagnosis
|
Description |
|
250.00 250.01 250.02 250.03 |
Diabetes
mellitus without mention of complication Diabetes mellitus without complication type
i not stated as uncontrolled Diabetes
mellitus without complication type ii or
unspecified type uncontrolled Diabetes
mellitus without complication type i
uncontrolled |
Items
Qualified for |
|
If a patient
is qualified, they may receive the following items:
- One Pair of
Therapeutic Shoes
- Three Pairs of
Custom or Pre-Fabricated Inserts (Per
Calendar Year)
|
Reimbursement Analysis
|
|
|
|
|
|
|
| |
|
|
|
|
|
Therapeutic Shoes |
A5500 |
2 |
$66.76 |
$133 |
| |
|
|
|
|
|
Custom Inserts |
A5513 |
6 |
$40.65 |
$244 |
| |
|
|
|
|
|
Total Billed |
|
|
|
$377 |
| |
|
|
|
|
|
Medicare Reimburse
@ 80% |
|
|
|
$301 |
| |
|
|
|
|
|
Average Cost |
|
|
|
$131
|
| |
|
|
|
|
|
Medicare Margin |
|
|
|
$170 |
| |
|
|
|
|
|
Other 20% Margin |
|
|
|
$76
|
| |
|
|
|
|
|
Total
Potential Margin |
|
|
|
$246
|
|
|
| |
|
| |
|
Encore ED Vacuum
Devices |
Certification & Training
Medicare does not require any education or
certification to provide these products.
If you are considering providing ED Vacuum
Devices, contact your Accreditation company to
determine the certification requirements. |
Who
Qualifies |
|
The following indication must be
met: ● Patient has to have been treated for Erectile
Dysfunction by their Physician |
|
Diagnostic
Codes |
|
Diagnosis
|
Description |
|
607.84 |
Organic
Impotence |
Items
Qualified for |
|
If a patient
is qualified, they may receive the following items:
- Any of the 3 Encore Revive Devices - Deluxe Combo,
Battery, or Manual
- 1 Unit
every 5 years
|
|
Reimbursement Analysis |
|
|
|
|
|
|
|
|
|
|
|
Medicare |
Medicare |
Average |
Average |
Average |
|
|
|
Allowable |
Average |
Medicare |
Dealer |
Medicare |
|
Description |
HCPCS |
Range |
Allowable |
Reimb. |
Cost |
Margin |
|
|
|
|
|
|
|
|
|
Deluxe Combo |
L7900 |
$435 - $580 |
$490 |
$392 |
$130
|
$262
|
|
|
|
|
|
|
|
|
|
Battery |
L7900 |
$435 - $580 |
$490 |
$392 |
$85
|
$307
|
|
|
|
|
|
|
|
|
|
Manual |
L7900 |
$435 - $580 |
$490 |
$392 |
$75
|
$317
|
|
|
|
|
| |
|
| |
|
VitalWear Systems |
Certification & Training
Medicare does not require any education or
certification to provide these products.
As of April 1, 2011,
Medicare declassified the code (E0217) for this
product line and NO longer reimburse for it.
Most Private Insurance companies are continuing
to reimburse for this product line for workmen's
compensation and personal injury protection
needs. |
Who
Qualifies |
|
The following indication must be
met: ● To relieve pain and improve circulation |
|
Diagnostic
Codes |
|
Diagnosis
|
Description |
|
714.00
714.89 715.90 728.85 721.30
721.90 724.30 782.30 459.80 |
Rheumatoid Arthritis Inflamm Polyarthrop-NEC Osteoarthrosis NOS - Unspec Muscle Spasm Lumbosacral Spondylosis Spondylosis NOS w/o Myelop Sciatica Edema Poor Circulation |
Items
Qualified for |
|
If a patient
is qualified, they may receive the following items:
- VITALWEAR
System - Includes System and 1 Wrap (1
unit every 5 years)
|
|
Reimbursement Analysis |
|
|
|
|
Amount |
|
|
Description |
HCPCS |
Qty |
Billed Range |
|
|
|
|
|
|
|
|
VITALWEAR System & 1 Wrap |
E0217 |
1 |
$443 - $521 |
|
|
|
|
|
|
|
|
Medicare Reimburse @ 80% |
|
|
$354 - $416 |
|
|
|
|
| |
|
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
|