Insurance Coverage / Reimbursement

Most customers purchase directly from elitone.com and provide payment at the time of purchase. Elidah, the maker of Elitone, does not process insurance claims.

This guide is provided to assist individuals who wish to pursue insurance coverage or reimbursement. Elidah makes no guarantee that an individual will be able to obtain coverage or reimbursement. Additionally, since insurance/reimbursement is by a 3rd party, the price, free shipping, return policy, and free gift offers are not available to those purchasing by these means.

Please note, that the time to receive your product through insurance can take months, depending on multiple factors including the completeness of your prescription, chart notes, and the in-network DME partners we have.

Detailed Written Order (Rx Form)
Reimbursement Guide & DWO
Elitone Info for Doctor & DWO

Medicare

Elitone has nationwide coverage through traditional Medicare. It is considered Durable Medical Equipment (DME), which requires Medicare customers to obtain it from a licensed DME provider.  The DME provider will rent you an Elitone on a monthly basis, typically 13 months, after which you own the product. You will be responsible for any out-of-pocket cost, often as a monthly copay. You will need:

  • A prescription for Elitone from a treating physician (see Detailed Written Order), including a statement of Medical Necessity.
  • Physician documentation (e.g., chart notes) showing that you tried and failed an ordered 4-week pelvic floor muscle exercise trial.
  • (Preferred) Chart notes describing that neuromuscular electrical stimulation is needed prior to advancing to more invasive surgical or implantable treatments.
  • Note: Medicare Advantage is not traditional Medicare; coverage is state-dependent, and we may not have a DME provider in your state.

Prescriptions and supporting documents that is sent to Elidah (FAX: 833-830-1310) will be forwarded to a DME provider if not state-specific

The following infographic depicts the Medicare process. Processing time varies from several weeks to several months.

ELITONE Reimbursement Process

Private Insurance

Many private insurers provide coverage for devices like Elitone. Every insurer has different coverage policies and requirements. Ask your insurance provider if they cover Elitone (use the Product and Manufacturer information below) and whether there are pre-requirements (see examples under the Medicare section).

  • If you meet the requirements, your insurer may provide reimbursement after completing your purchase from elitone.com.
  • If your insurer requires an “in-network” provider, contact us at customercare@elitone.com, and we may be able to pair you with a provider in your state.

Medicaid

Medicaid is state-specific. Although the list is growing, Medicaid can cover Elitone in the following states: Arkansas, Idaho, Minnesota, Oklahoma, Texas, Washington

  • The requirements vary in these states, so please contact clinicians@elitone.com for more information.

Product and Manufacturer Information

Manufacturer: Elidah, 810 Main St. Ste C, Monroe, CT 06468

Customer Care Contact:  customercare@elitone.com or 978-435-4324

Product Name HCPCS/DME Code Description
ELITONE E0740-NU Non-implanted pelvic floor electrical stimulator, complete, Purchased new.
ELITONE URGE E0740-NU Non-implanted pelvic floor electrical stimulator, complete, Purchased new.
ELITONE GelPads Pack of 5 A4595 Electrical stimulator supplies

Additional reference diagnostic codes that your insurer or physician might ask for include:

  • NCD Code – 230.8 (Non-implantable pelvic floor electrical stimulator)
  • CPT Code – Pelvic Floor Electrical Stimulation with 599.82 Intrinsic (urethral sphincter) with 625.6 Stress Incontinence, female
  • ICD-10-CM Code – N39.3 Stress urinary incontinence (SUI)
  • ICD-10-CM Code – N39.41 Urge urinary incontinence (UUI)

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