Reimbursement Support Made Simple
At Insightec, we are committed to helping providers and patients navigate the reimbursement process for MR-guided Focused Ultrasound (MRgFUS) treatment. Our goal is to ensure access to treatment by providing the following tools, resources, and support needed to secure coverage.
Support for Providers
Our dedicated reimbursement team is available to assist healthcare professionals with:
- CPT and ICD-10 coding guidance
- Benefits verification
- Prior authorization and predetermination support
- Appeals for denied claims
- Documentation best practices to support medical necessity
Reimbursement Resources
We offer a comprehensive MR-Guided Focused Ultrasound Reimbursement Guide that includes:
- Covered indications and diagnosis codes
- Medicare and commercial payor coverage landscape
- CPT coding and payment information
- Documentation tips for medical necessity
- State-by-state coverage insights
Download the MRgFUS Reimbursement Guide
Important Reimbursement Information
This information does not constitute a guarantee of coverage and should not be considered a determination of coverage. Coverage, reimbursement, and other insurance-related decisions are made by individual insurers and may vary from region to region. Codes, values, and policies are subject to change without notice.
Established Reimbursement
Focused ultrasound for essential tremor has established reimbursement nationwide, making access more seamless for patients and providers.
- Medicare coverage available in all 50 states
- Favorable coverage from the majority of national private payers (Aetna, Anthem, Cigna, Humana, BlueCross BlueShield, Tricare, and others)
- Nationwide reach with treatment centers across the country
- CPT Category I code effective January 1, 2025 for routine physician payment
- 235M+ lives covered across the U.S.
Source: Coverage information and covered lives estimates are based on publicly available information from individual health plan websites and policy documents. Data reflects information available at the time of publication, and coverage policies are subject to change at any time.
Patient Advocacy Program
If your patient’s insurance does not currently cover Insightec’s MR-guided focused ultrasound treatment, our Patient Advocacy Program may be able to help. This program is designed to:
Educate
Provide insurance providers with information on the clinical and economic value of MR-guided focused ultrasound
Support
Support patients and providers through the prior authorization or appeals process
Assist
Offer personalized assistance from our reimbursement support team
Patient Requirements
- Patients must agree to participate in the advocacy program and authorize use of their medical information
- Patients must qualify for treatment clinically and have a letter of recommendation or appeal to distribute accordingly
- In addition, at the request of a Health Care Professional to faciliate patient access to the Insightec’s technology, and subject to appropriate privacy safeguards, the Company may assist the patient by facilitating the preparation and submission of requests for coverage determinations, prior authorizations, pre-certifications and appeals of denied claims, relating to Insightec’s MRgFUS treatment.
Expected Outcomes
The program’s purpose is to educate insurance providers so they can ultimately support your patient’s access to treatment.
Contact
To learn more or submit your case to the Patient Advocacy team:
This is not a full summary of the labeling, refer to the Insightec Exablate Neuro “information for prescribers” documentation for valuable information on intended use, contraindications, risks and side effects, technical performance specifications, and detailed operating instructions. Information provided in this document and any reimbursement support is for convenience and general information purposes only. It is obtained from publicly available, third-party sources and is subject to error, omission or change without notice due to complex and frequently changing laws, regulations, rules, and policies. Insightec makes no representation, statement, promise or guarantee of coverage or levels of reimbursement. Payments will vary by geographic location and payor. Always refer to the patient’s insurance plan and/or the local Medicare Administrative Contractor for Local Coverage Determinations (LCDs) and for any additional requirements and guidance for coding, coverage, and payment.
PRP-0000471 Rev1
This is not a full summary of the labeling, refer to the Insightec Exablate Neuro “information for prescribers” documentation for valuable information on intended use, contraindications, risks and side effects, technical performance specifications, and detailed operating instructions. Information provided in this document and any reimbursement support is for convenience and general information purposes only. It is obtained from publicly available, third-party sources and is subject to error, omission or change without notice due to complex and frequently changing laws, regulations, rules, and policies. Insightec makes no representation, statement, promise or guarantee of coverage or levels of reimbursement. Payments will vary by geographic location and payor. Always refer to the patient’s insurance plan and/or the local Medicare Administrative Contractor for Local Coverage Determinations (LCDs) and for any additional requirements and guidance for coding, coverage, and payment.
PRP-0000471 Rev1