Reimbursement Support Center
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 email@example.com.