How To Get Reimbursed from Insurance Companies and Medicare for the Rebuilder Medical.

Note: ReBuilder Medical Technologies, Inc does not submit insurance claims for customers.

The ReBuilder has two separate FDA registrations: one is as a TENS device and the other is as an EMS device. The best way to get Medicare and Blue Cross 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, Medicare and Blue Cross may request from the doctor their own form.

Codes:

DME code: E0720, TENS, Brand specific, ReBuilder Model #2407 (primarily for Medicare - maximum allowance single payment $367.58) Diagnosis is chronic, intractable pain. Requires Medical necessity form and prescription and patient history of failed alternatives such as pain meds.

Medicare policy

' When used for the treatment of chronic, intractable pain, the TENS unit must be used by the patient on a trial basis for a minimum of one month (30 days), but not to exceed two months. The trial period will be paid as a rental. The trial period must be monitored by the physician to determine the effectiveness of the TENS unit in modulating the pain. For coverage of a purchase, the physician must determine that the patient is likely to derive significant therapeutic benefit from continuous use of the unit over a long period of time. The physician's records must document a reevaluation of the patient at the end of the trial period, must indicate how often the patient used the TENS unit, the typical duration of use each time, and the results."
DMERC Region D Supplier Manual, Chapter 9, TENS-1 through TENS-3, Revised 10/1996, Reprinted 7/2001.

Also as an alternative: DME code E0745 Neuromuscular Stimulator Electronic Shock Unit. Medicare pays maximum $89.51 for 3 months, then 75% of that for 13 months as a capped rental. diagnosis of disuse muscle atrophy with intact nerve, unrelated to neurological deficits. (DX code 728.2). Note: This code may result in a denial labeled "experimental" so this code is not a good one to use.)

>Most major private plans will pay 80% of cost in single payment with prescription.

CPT for attended electrical stimulation: 97032
CPT for unattended electrical stimulation: 60283
CPT for patient training: 64550Chronic, intractable pain

DME Codes:

E0720 TENS localized, two lead stimulator
A4558 Conductive Gel
A4595 TENS supplies, 2 lead per month
A4630 Batteries, TENS owned by patient
A4556 Electrodes
A4557 Lead wires
E0731 Conductive garment (gloves and socks) for TENS or NMES with conductive fobers separated from patient's skin by layers of fabric.h