Reimbursement Support Center


Overview

Relievant is committed to providing patients, physicians and facilities with resources to assist in the reimbursement process and to gain patient access for treatment with the Intracept Procedure. Relievant has a dedicated team of professionals to assist in the prior authorization of the Intracept Procedure. The prior authorization process involves obtaining advance notification from an insurance company that medical necessity and other coverage criteria have been met as set forth by the insurance company. The Relievant team works alongside the patient and physician throughout the prior authorization process in an attempt to obtain approval for the Intracept Procedure.

The Intracept Procedure is an outpatient procedure that is typically performed in either a hospital outpatient department (HOPD) or an ambulatory surgery center (ASC). As of January 1, 2019, the Centers for Medicare and Medicaid (CMS) has established two C-Codes, C9752 and C9753, for the Intracept Procedure. These new codes have been assigned to APC 5115. Facilities working with payers that do not recognize C-Codes may use CPT code 22899, unlisted procedure, spine. Reimbursement by a payer will depend upon the contract with the facility.

Patient Access Program

The goal of Relievant’s patient access program is to assist patients in navigating the process to obtain prior authorization for the Intracept Procedure. As part of the process we educate insurance companies on the patient benefits and clinical significance of the Intracept Procedure with the ultimate goal of establishing positive coverage policies for the Intracept Procedure. The program involves:

  • Prior Authorization: Relievant works with physicians to obtain the clinical documentation that demonstrates medical necessity to submit to the patient’s insurance company
  • Internal Appeal: If the insurance company does not approve the prior authorization, Relievant works with physicians and patients to submit appeal letters and additional materials to assist in demonstrating medical necessity
  • External Appeal: If the insurance company does not approve the prior authorization after internal appeal(s), some patients may have the right to request an external review with an Independent Review Organization (IRO) and the Relievant team will assist physicians and patients throughout this process


Intracept is supported with Level l clinical evidence, has 510(k) Clearance, and is commercially available in the United States. For more information on the patient access program and reimbursement support, please contact Relievant’s reimbursement team at reimbursement@relievant.com.

Relievant Medsystems, Inc. is pleased to provide general information on coding, coverage and payment. This information is not intended to be legal or financial advice. Nothing stated above should be construed as a guarantee by Relievant of coverage or payment for Intracept Procedures. Nothing should be viewed as an instruction to use a particular code or influence levels of payment. Providers are responsible for exercising their independent clinical judgment and reporting the codes that accurately reflect the patient’s condition and the services rendered and submit bills consistent with the patient’s insurer’s requirements. Reimbursement changes annually. This information is accurate as of January 1, 2019. Providers are advised to consult with the applicable payer or the specialty society or legal counsel for any coding, payment or billing related issues.