CUSTOMER SERVICE: Medicaid Coverage

Medicaid

Medicaid patients qualify for a $100 discount on the purchase of a Fisher Wallace Stimulator®. Depending on the state, Medicaid may reimburse patients for the purchase of a Fisher Wallace Stimulator® when it is prescribed for the treatment of pain using the procedure code E0720. A letter of medical necessity may be required to obtain coverage. You may download a template of this letter. Your doctor will need to edit the template to reflect your particular situation.

When our device is administered by the healthcare provider, the following CPT codes apply for Medicaid coverage (fees vary by state):

Initial Office Visit (assessment only) / Code 99215 (office visit for established patient): Patient is assessed and provided with a self-assessment symptom tracking document.

Office Visits for Treatment / Codes 99213 or 99214 (office visit) plus two billings of 97032GP (electrical stimulation, manual, 15 min) per visit to cover the 20-minute treatment session plus set up and breakdown. Ideally, a minimum of nine visits occur within a two-week period (five consecutive days, followed by four consecutive days).

Concluding Assessment / Code 99215: If the patient reports significant improvement and no significant adverse events, he/she may be provided with a device for use at home using code E0720NU or E1399. A letter of medical necessity may be required to obtain coverage.

New York State Residents with Medicaid coverage may be able to secure coverage if they have a secondary insurance plan that works with Integra Partners. Integra Partners is a full-service network connecting Orthotics and Prosthetics (O&P) and Durable Medical Equipment (DME) providers. You can find insurers that work with Integra Partners using this form. When requesting coverage, make sure your prescription is written for chronic pain, and use E1399 (miscellaneous electrical stimulation) as the equipment code.