Overview | Additional Information | Billing Codes | Medicare | Medicaid

 

Insurance Billing and Coverage

 

Overview

As a courtesy to our customers, CMR will  bill the patients insurance company for motion Therapy Products. Billing for these products is difficult and our extensive experience improves the chances equipment will be covered.

 

In billing the patients insurance, we make every effort to have the equipment and therapy covered, including requesting pre-authorizations, pre-determinations and 1st level appeals. We also provide support in further appeals both through the insurance company and state insurance agencies.

 

For this process, we generally require a prescription, patient insurance information, doctors notes, and a letter of medical necessity for mobilization products.

 

Comfort and recovery products are not covered by insurance; for these we will bill the patient directly and they can request reimbursement for the items.

 

Overview | Additional Information | Billing Codes | Medicare | Medicaid

 

Additional Information:

  • We cannot guarantee that the patient's insurance company will pay any portion of the patients bill. 
  • All claims must be submitted with a prescription from the treating physician.
  • We will pre-authorize or pre-determine the patients coverage when possible. We make every attempt to pre-authorize the products/services that we provide, however, we will only appeal a pre-authorization denial, except when the denial is for non-covered benefit or TMJ exclusions.
  • If the patients claim gets denied as investigational or experimental, we will file a first level appeal on the patients behalf, and will assist in further appeals.
  • Any representation made by a CMR, Inc. agent about a patient's insurance coverage is based on information provided by your insurance company and, again, should not be considered a guarantee of payment.
  • Claims can only be determined eligible/ineligible at the time it is processed, and may be denied even after a pre-authorization or pre-determination is issued.
  • You may be required to submit additional information requested from your insurance company.
  • Be aware that any payment sent to you from your insurance company for services rendered to you by CMR, Inc. must be forwarded to us calling or mailing in the payment for that amount.
  • You may be responsible for any amount that is not covered by your insurance company, especially including any co-pays or deductible. We do follow the guidelines set forth by your state’s insurance personal injury protection (PIP) that only allows us to bill the insurance company if your injury is determined to be related to the accident.

 

Overview | Additional Information | Billing Codes | Medicare | Medicaid

 

Billing Codes:

  • CPM Device Rental - EO935
  • CPM Oral Interface (single-patient use) - E1399
  • OraStretch Press and TheraBite System - E1700

 

Overview | Additional Information | Billing Codes | Medicare | Medicaid

Medicare

Medicare is divided between traditional Medicare and the newer Medicare+Choice (or Medicare Advantage plans). These two plan styles are dramatically different in their methods of coverage. Please see the plan style that corresponds to your coverage.

 

Traditional Medicare

Traditional Medicare is a classic pay-for-service system that generally covers doctor fees based on pay scales and formulas for the service. Traditional Medicare has two components Medicare A and Medicare B coverage. Medicare A covers hospital stays and nursing care. Medicare B covers doctor services, tests, some medication and durable medical equipment (DME). Medicare's coverage of DME generally pays 80% with patient responsibility for the remaining 20%. Each Medicare regional administrator has slightly different reimbursement rates, and final prices can only be determined after the equipment is provided and billed to Medicare. CMR's products are DME and some of them are covered by traditional Medicare, notably the OraStretch Press and the Therabite System are covered by traditional Medicare.

 

Medicare Advantage or Medicare + Choice

Medicare Advantage plans are paid for by the government, but are administered by separate insurance and HMO companies, like Blue Cross/Blue Shield, Aetna, Cigna, etc. Each company is allowed to set their own policies concerning coverage, and thus are nearly identical to non-Medicare insurance coverage. Please see above for more information on coverage by private insurers.

 

Overview | Additional Information | Billing Codes | Medicare | Medicaid


Medicaid

Medicaid is individually controlled by each state. CMR is not registered with Medicaid as a provider in any states and thus cannot bill Medicaid directly for provided equipment. We can work with you and your doctor to get equipment provided to you, but we cannot guarantee coverage.

 

Overview | Additional Information | Billing Codes | Medicare | Medicaid