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Letter of Medical Necessity

Appeal Letter

Cost Assessment Tool

PTNS Clinical Summaries

FDA Letter

General Questions
Uroplasty Reimbursement Group
5420 Feltl Road
Minnetonka, MN 55343
Tel: 866.258.2182
Fax: 866.344.0219
reimbursement@uroplasty.com

Disclaimer: Uroplasty assembled this coding, coverage and payment information as a convenient reference source. It is subject to change without notice as a result of changes in reimbursement laws, regulations and policies. This content is informational only and does not address all possible situations. No guarantee or promise of coverage or payment is represented herein. Providers assume full responsibility for accurate coding and reimbursement decisions and actions. All procedures and services should be accurately documented in the patient’s medical record. Please consult your payer organization if you have questions regarding its specific reimbursement guidelines.

Urgent® PC
Support Documents

Coding & Payment Fact Sheet

Reimbursement Process Review
Prior Authorization Process
Claim Submission Process

Reimbursement Flow Charts
Claim Appeal Process
Medicare Claim Appeal Process
Prior Auth Process
Prior Auth Appeal Process
Unlisted Code Claim Submission Process

Sample Letters
Sample Appeal Letter
Sample Patient Appeal Letter
Sample Letter of Medical Necessity
Sample Letter for Those who Previously Used 64555

Submission Guidance
Guidelines for Response Letter to Denied Claim

Sample Procedure Cost Assessment Tool
Procedure Cost Assessment Tool

Sample CMS 1500 Form
Unlisted Code Submissions Sample

Clinical Information
PTNS Clinical Highlights
PTNS Clinical Summaries
PTNS Procedure Overview
PTNS Treatment Steps

FDA Documentation
FDA Clearance Letter

Sample of Explanation of Benefits
Not Available