Reimbursement

Conceptus is committed to helping physicians make a seamless transition from performing hospital to in-office procedures. To that end, we are pleased to provide in-office reimbursement information to answer questions you and your staff may have about managing payers and other reimbursement issues. The majority of commercial third-party payers cover the Essure procedure as a benefit for women who have completed childbearing and desire permanent sterilization. The key to obtaining successful reimbursement lies in accurate coding, clean claims submission, and timely follow-up of any denials.

Be sure to research coverage and documentation requirements for each patient as policies and guidelines can vary by payer and by plan.

General guidelines for successful reimbursement include:

• Identify a staff member to coordinate the prior authorization and pre-certification process with payers and facilities
• Involve the patient and/or family in the prior authorization process, as appropriate
• Follow the payer’s conditions for coverage (COC)
• Prepare a clear and concise letter of medical necessity
• Educate the payer regarding the therapies provided by the physician, as needed

Find detailed information in the following:

• Physician Coding Guide
• Facility Coding Guide

Learn more:

• Essure technology for an innovative leap forward in birth control
• No incisions. Minimal anesthesia. Excellent patient tolerance
• Essure Clinical Studies – Safe and easy procedure and zero pregnancies among Essure users in over five years of clinical trials