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Reimbursement for Patients Covered by Private Insurers
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| Private Insurance Coverage |
Private payers have different coding and reimbursement guidelines,
especially regarding new procedures. Coverage and reimbursement amounts
will also vary based on contractual arrangements with the individual payers.
Many payers follow Medicare policy (see Medicare procedure page) in paying for the Omnisense 7000S bone
test and reimburse at an equal or higher level per study.
Contact the patient's third-party payer for their specific coverage
guidelines regarding testing for osteoporosis.
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There is currently no law similar to Medicare that standardizes coverage
criteria and reimbursement rates. We suggest that a denial of payment should be
challenged if the test seems to meet the Medicare criteria for coverage.
A letter addressed to the medical director with additional
information should be considered. Contact Sunlight Medical, Inc. for a form letter.
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The coding, coverage, and payment information contained herein is gathered
from third party sources and is subject to change. The codes listed are
possible coding options. It is always the provider's responsibility to
determine and submit appropriate codes, charges, and modifiers for the
services that are furnished. Providers should contact their local payers
for specific information on pertinent coding, coverage and payment policies
before a claim is submitted. Sunlight Medical Inc. cannot guarantee success
in obtaining payments for medical services.
Click here to return to the 7000S product page
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