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The process of selling, delivering, training, billing, and collecting reimbursements for the Cybertech Back Braces, follow a similar process as with most DME products.  Below, we take you through each of the steps along with estimates for billing and reimbursements.

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Who Qualifies?

One of the following indications must be met:

●  To reduce pain by restricting mobility of the trunk; or

●  To facilitate healing following an injury to the spine or related soft tissues; or

●  To facilitate healing following a surgical procedure on the spine or related soft tissue; or

●  To otherwise support weak spinal muscles and/or a deformed spine.


In order for a patient to qualify under Medicare guidelines for the Cybertech Back Brace, an Rx is required from the Doctor indicating that there is a Medical Necessity for the patient to receive the Cybertech Back Brace.  Some of the diagnosis's include:


Diagnosis 

 Description

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724.0
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756.12
722.10
721.3
847.2
724.9
722.52

 

Lumbago
Spinal Stenosis
Muscle Weakness
Spondylolisthesis
Lumbar Disc Displacement
Lumbosacral Spondylosis
Lumbar Strains/Sprain
Spinal Disorder
Lumbar/Lumbosacral Intervertebral Disc Degeneration

 

 
Items qualified for

If a patient is qualified, they may receive the following items:

  • 1 Cybertech Back Brace - Includes Brace & appropriate Panels (1 unit every 5 years)
Doctors - Prescription (Rx)

Upon patient qualification and before placing an order, it is necessary to receive the approval from the patient's primary Doctor.  The Prescription Rx form is sent or faxed to the Dr. for their signature. 

Patient's authorization to bill Medicare

The standard patient authorization form needs to be signed by the patient and returned prior to billing Medicare. 

Billing Medicare & Supplemental Insurance

Upon completion and certification that the Cybertech Spine Brace has been delivered and accepted by the patient, the Medicare Provider company then bills Medicare, Supplemental Insurance, and possibly the patient for the co-pay amount.

Below is a schedule that shows the approximate Medicare billing amounts and reimbursements:

The Medicare allowable for the Cybertech Back Braces varies by State with the ranges given below

 

Cybertech - Back Braces
Reimbursement Analysis
           
           
  Medicare Medicare Average Average Average
  Allowable Average Medicare Dealer Medicare
Description HCPCS Range Allowable Reimb. Cost * Margin
           
Ergo Spine Brace Flex Power Plus w/Panels L0627 $316 - $422 $369 $295 $105 $190
           
Ergo Premium Plus w/Panels - 8" L0631 $791 - $1,055 $923 $738 $205 $533
           
Ergo Premium Plus w/Panels - 10" L0631 $791 - $1,055 $923 $738 $215 $523
           
Ergo Tri-Mod w/Frame & Panel - 8" L0637 $904 - $1,205 $1,054 $843 $205 $638
           
Ergo Tri-Mod w/Frame & Panel - 10" L0637 $904 - $1,205 $1,054 $843 $215 $628
           
           
* Average Dealer Cost includes shipping.            

 
Certification & Training

Cybertech Back Braces - Medicare does not require any education or certification to provide the Cybertech Back Braces - in most statesBefore selling these products we recommend that you contact Medicare to determine if there are any specific requirements to provide the Pre-fabricated back braces. 
 


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