TRD D01 and D02 Study Patient Reimbursement Assistance Program

Cyberonics is proud of its unwavering commitment to improve the lives of people touched by chronic or recurrent, treatment resistant depression (TRD). Due to the courage, determination, and pioneering spirit of you and your patient, VNS Therapy is the first FDA approved treatment option for Americans with TRD. The purpose of the Study Patient Reimbursement Assistance Program is to ensure that the D-01 and D-02 VNS Therapy study patients maintain uninterrupted access to VNS Therapy

TRD D-01 and D-02 Study Patient Reimbursement Assistance Program Patient Letter

Process to Initiate the TRD D-01 and D-02 Reimbursement Assistance Program:

Download a process flowchart

1. The provider contacts the Study Patient Reimbursement Assistance Program by calling 800-332-1375, ext 7529
• The following forms will be provided:
• Study Patient Reimbursement Assistance Form that includes the serial number of the device to confirm the study patient’s status as a D-01 or D-02 patient. Submission of this form indicates acceptance of the payment rate which will be reimbursed if the claim is denied by the payer (see rates below)
• Insurance Verification and Education Authorization Form (IVEA), which authorizes Cyberonics to verify the patient’s insurance benefits
• Fill out, sign, and fax both to 888-577-7205 to initiate the process
2. Insurance Verification and Education Authorization Form (IVEA) Process
• Upon receipt of IVEA Form, a verification specialist will initiate the verification process for patient benefits.
• A case manager will handle any prior authorization requirements
3. The provider files the claim with the payer
• If the provider receives payment, no further action is needed
• If the claim is denied, denial support will be provided by a regional alliance manager, who will work with the provider on the appeal process, following up with the payer to appeal the claim
4. Study Patient Reimbursement Assistance
• When all denial appeals are exhausted, Cyberonics will authorize payment for the following codes based on the Average National Medicare rates for calendar year 2006: (reference point).
  

  Reimbursement Rates*
  Procedure Code	Rate
  95974* – dosing	$175.82
  95970* – testing	$48.12
  64573* - device implant(surgeon)	$519.14
  61885* - lead implant (surgeon)	$461.26
  61888* - removal of device (surgeon)	$364.30
  64585* - removal of lead (surgeon)	$364.30
  APC 0039 - device implant (hospital)	$11,602.80
  APC 0225 – lead implant (hospital)	$14,928.24
  APC 0688 - removal of device (hospital)	$2,550.57
  APC 0687- removal of lead (hospital)	$1,142.39

5. Cyberonics will communicate with provider in reference to payment
• Payment will be authorized, and a check will be issued