Insurance Coverage / Reimbursement
Elidah, the maker of ELITONE, does not process insurance claims. Most customers purchase directly from Elidah (elitone.com) and provide payment at time of purchase. 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.
ELITONE has nationwide coverage through traditional Medicare. It is considered Durable Medical Equipment (DME), which requires Medicare customers must 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 health insurance processer if not state-specific
The following infographic depicts the Medicare process. Processing time varies from several weeks to several months.
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 Medicare section).
- If you meet the requirements, you insurer may provide reimbursement after completing your purchase from elitone.com.
- If your insurer requires an “in-network” provider, contact us at email@example.com, and we may be able to pair you with a provider in your state.
Product and Manufacturer Information
Description: Non-implantable pelvic floor electrical stimulator
HCPCS/DME Code” E0740
Manufacturer: Elidah, 810 Main St. Ste C, Monroe, CT 06468
Customer Care Contact: firstname.lastname@example.org or 978-435-4324
|Product Name||HCPCS 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)