CUSTOMER SERVICE: Medicare
Medicare patients qualify for a $100 discount on the purchase of a Fisher Wallace Stimulator®. Medicare may reimburse patients for the purchase of a Fisher Wallace Stimulator® when it is prescribed for the treatment of pain using the procedure code E0720. A letter of medical necessity may be required to obtain coverage. You may download a template of this letter. Your doctor will need to edit the template to reflect your particular situation.
When our device is administered by the healthcare provider, the following CPT codes apply for Medicare coverage:
Initial Office Visit (assessment only) / Code 99215 (office visit for established patient): Patient is assessed and provided with a self-assessment symptom tracking document.
Office Visits for Treatment / Codes 99213 or 99214 (office visit) plus two billings of 97032GP (electrical stimulation, manual, 15 min) per visit to cover the 20-minute treatment session plus set up and breakdown. Ideally, a minimum of nine visits occur within a two-week period (five consecutive days, followed by four consecutive days).
Concluding Assessment / Code 99215: If the patient reports significant improvement and no significant adverse events, he/she may be provided with a device for use at home using code E0720NU or E1399. A letter of medical necessity may be required to obtain coverage.
For Patients with Secondary Insurance: If you have a secondary insurance plan in addition to Medicare, that plan may cover the device. To apply for coverage from your secondary plan, you first need to receive a denial of coverage from Medicare. To receive your denial, submit this 1490S Medicare form. In addition to the form, you will need your prescription, proof of payment and a cover letter stating that you are requesting a denial. All information needs to be sent to the Medicare Durable Medical Equipment address in your state. The address for each state is listed on the form. Once you receive a denial from Medicare, you can submit it to your secondary insurance carrier.