Arthrex provides product-specific information about codes and billing scenarios that may be used for procedures that employ our products. Payment methods for these technologies will vary by payer and site of service. Payer policies, and the laws and regulations that guide them are complex and change frequently. Ultimately, the provider of a service is responsible for decisions regarding coding, coverage and reimbursement matters.
Please review our FAQ page to see if your questions can be answered quickly. For in-depth discussion about coverage, payment or coding, we offer reimbursement hotlines to assist you. Please contact:
Arthrex Coding Hotline
1-877-734-6289
Cartiform® Viable Osteochondral Allograft
1-866-988-3491
ArthroFLEX®† Dermal Allograft Pre-Authorization
1-877-734-6289
Arthrex Amnion™ Matrix and BioCartilage® Extracellular Matrix Pre-Authorization
1-877-734-6289
Email: arthrex@mcra.com
Alternatively, please send questions and comments to an Arthrex reimbursement specialist via the form below.
The Arthrex Reimbursement Hotline is designed to assist health care providers and their staff by providing reimbursement assistance for Arthrex products and procedures.
The Reimbursement Hotline can assist in the following areas:
- Share insurance guidelines for commercial and government health programs
- Assist providers on payer specific claims submission requirements
- Provide published CMS fee schedules and payment process methodologies
- Provide coding information specific to payer requirements and coding guidelines
The Arthrex Reimbursement Hotline cannot:
- Submit a claim or an appeal
- Guarantee coverage or specific payment level
- Complete Medical Necessity documentation on behalf of the prescribing physician
- Represent a provider during appeals process with payers
- Recommend what providers charge for Arthrex products
- Tell the provider what codes should be used to “maximize” reimbursement
The Centers for Medicare and Medicaid Services provide additional information on reimbursement, including an option to search for both National and Local Coverage Decisions.
As of October 1, 2015, CMS has implemented the ICD-10 Medicare Coding implementation.
Disclaimer: The information provided on this website was obtained from many sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. All content on this website is informational only, general in nature, and does not cover all situations or all payers' rules and policies. This content is not intended to instruct medical providers on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that we assume will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for healthcare procedures.
This website information represents no promise or guarantee concerning coverage, coding, billing, and payment levels. Arthrex specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information on this website or through the hotline. It does not constitute legal advice and no warranty regarding completeness or accuracy is implied. The essential components which determine appropriate payment for a procedure or a product are site of service/coding/coverage/payment system/geographical location/national and local medical review policies and/or payer edits.
† ArthroFLEX is a registered trademarks of LifeNet Health.