Is ELITONE covered by insurance?
In addition to determining the correct urinary incontinence ICD 10 code, treatment devices correlate with certain codes. HCPCS code E0740 applies to “non-implantable pelvic floor muscle stimulators,” including ELITONE. Note that PDAC (Pricing, Data, Analysis and Coding Contractor) recently reviewed this code and found that many previously covered devices, specifically those that provide biofeedback (i.e., electromyography) but do not provide e-stim, do not fall within the scope of E0740 and are not covered. To fall within the category of the code, the device must deliver stimulation that exercises the pelvic floor muscles.
ELITONE received approval to utilize E0740 shortly after it received FDA clearance. Many private insurers cover ELITONE and have published coverage decisions (e.g., United Healthcare). Although requirements vary, most insurers have two stipulations: a prescription and failed improvement with four weeks of pelvic floor exercises.
Unlike other e-stim devices, ELITONE is also available as an FDA-cleared, over-the-counter (OTC) product and can be purchased by patients directly from the ELITONE website. This is an excellent solution for patients without insurance coverage or who want immediate access to treatment.