Always provide the HMO, insurance company or third party payer with the following:

1. Clinician's prescription for the Fenix Rehab System
2. A description of the product and its use along with clinical justification for the application of the Fenix Rehab System, as well as an explanation of how the patient will benefit from its use.
1. The customer need an appropriate insurance claim form from the clinic's billing department or from their insurance provider.
2. Then have the completed claim form with the clinician's prescription and justification for the Fenix Rehab System sent to the insurance provider
3. If the patient paid for the Fenix Rehab System our of their pocket, make sure that a copy of the paid invoice is attached to the claim form, prescription and justification.

Suggestion:
If the initial claim for an insurance company is denied, resubmit the claim. Justify the Fenix Rehab Systems benefits and features in simple terms and outline the cost savings realized, by them and the patient by utilization of the System by the patient.

CPT Codes:
CPT (Current Procedural Terminology) Codes are published by the American Medical Association. Originally intended for use by physicians, the CPT Codes are now widely used by other health care practitioners to concisely and accurately describe any action taken by a medical professional.

Disclaimer:
FRE, Inc. does not guarantee eligibility for reimbursement for you or your patient if you use the codes suggested below. These are given only a guidelines for you to use base on you clinical expertise Also, we do not guarantee that the product is eligible for reimbursement since reimbursement criteria and policies vary widely from state to state throughout the United States.

Proper diagnosis of the condition and the actual medical necessity for the Fenix Rehab System, the coverage provided by the patient's policy, as well as other special issues can determine whether or not an insurance carrier, or third party payer will reimburse the cost of any particular product or procedure including this system.

Submissions: CPT codes for product purchase reimbursement

1. A code that has been reportedly been used to report the sale of tools to the patient that that mimic the action of the hands, including trigger pint tools such as the Fenix Rehab System, is CPT code 99070.
   "Supplies and materials provided by physician over and above those usually included with the office visit."
2. Possibly the CPT Code 97039 - "unlisted modality" may work when a description is sent along with the prescription and justification.
3. If used to apply traction to the cervical spine E0850 could possibly be utilized and if used for lumbo-pelvic traction, E0880.
4. There is also Miscellaneous Durable Medical Equipment (ME) 1399 which would need a description along with the prescription and justification.
5. Always include a physician's prescription for the Fenix Rehab System and documentation that describes the System as well as explains how the patient will benefit from its use.
6. Submit these items to your billing department to forward to the appropriate insurance company.

Example of Possible Justification for Fenix Rehab System Use:
* Actual justification must be based on your evaluation of the patient and their actual condition.
The patient's current condition and level of pain and dysfunction requires two or more hours of hands-on manual therapy each week to inactivate myofascial trigger points. Use of the Fenix Rehab System allows the patient to apply active therapies at home to assist in the inactivation of myofascial trigger points (MTrPs), the major cause of muscle-skeletal pain according to Melzack and Wall (1989).

The application of the Fenix Rehab System to inactivate MTrPs in the patient's back, neck or extremities will reduce pain, improve flexibility and overall function resulting in the likely reduction in length of time for recovery. The study by Hanel et al in Physical Therapy, Volume 10, October 2000, demonstrated that, "clinicians can manage ... pain associated with TPs through a home program of ischemic pressure..."

Submission CPT Codes for Fenix Rehab System Training:
CPT Code 97535 - Home management training/Self-care and instruction in use of assistive technology devices

   

Submission CPT Codes for Fenix Rehab System Monitoring on subsequent visits:
Each visit if you find and demonstrate active and latent MTrPs, gauge progression of range of motion and muscle strength in your patient, and justify you therapeutic procedure by, ""effecting change through the application of clinical skills and /or services that attempt to improve function," you can possibly utilize these CPT Codes in the monitoring of your patient's home use of the Fenix Rehab System.

1. CPT Code 97112 - Neuromuscular re-education of movement, balance, coordination, posture
2. CPT Code 97140 - Manual Therapy/Myofascial release
3. CPT Code 99213 - Evaluation and Management service provided in the physician's office, on established patient.

Submission CPT Codes for Fenix Rehab System Support Materials:

1. CPT Code 99071 - Any educational supplies, such as books, videos and pamphlets provided by physician. (To be used when Fenix Rehab System support materials are provided to the patient, such as our patient educational DVD on chronic pain and fibromyalgia.)
2. CPT Code 97802 - Initial assessment for nutritional support for the patient's condition. CPT 97803 for their re-assessment.
3. CPT Code 99070 - Vitamins/or A9150 - nonprescription drugs - for the sale of the Fenix Rehab System nutraceuticals developed specifically for chronic pain and fibromyalgia.