Insurance Coverage for Scoliosis Treatment Costs

You will need the following information:

Name of patient: ______________________________
Patient’s date of birth:____________________
Identification # (found on the insurance card):_________________
Insurance company phone number (usually found on the front of the insurance card)

Call Insurance Provider and ask the following questions:

Are my benefits for a calendar year or benefit year?

If benefit year, ask for the dates:____________________________________ 

(Example: 07/01/08 through 06/30/09)

Is there any pre-authorization required?

If so, who do I call? _____________________________________________

 

DoES my insurance cover:

1. Spinal Manipulation – Code 98941   Yes or No

 

What is the coverage:
Is there a maximum number of visits? If so, how many?_____

Is there a deductible? If so,how much?______

Has any of the deductible been met? _____
If there is a deductible, what percentage will the

company pay versus myself ______________
(Example: 80% company / 20% patient)


Is there an Out of Pocket maximum? If so, what?___________

After this amount, the company will usually pay at 100%

Or instead of a deductible is there a co-pay? If so, what? _______

Is there a maximum dollar amount that the company pays per year?
If so, what? ______

2. Therapy – Codes 97012, 97140, 97110

 

What is the coverage:
Is there a maximum number of visits? If so, how many?_____

Is there a deductible? If so,how much?______

Has any of the deductible been met? _____
If there is a deductible, what percentage will the

company pay versus myself ______________
(Example: 80% company / 20% patient)


Is there an Out of Pocket maximum? If so, what?___________

After this amount, the company will usually pay at 100%

Or instead of a deductible is there a co-pay? If so, what? _______

Is there a maximum dollar amount that the company pays per year?
If so, what? ______



3. Office visits – Codes 99203, 99213, 99214

 

What is the coverage:
Is there a maximum number of visits? If so, how many?_____

Is there a deductible? If so,how much?______

Has any of the deductible been met? _____
If there is a deductible, what percentage will the

company pay versus myself ______________
(Example: 80% company / 20% patient)


Is there an Out of Pocket maximum? If so, what?___________

After this amount, the company will usually pay at 100%

Or instead of a deductible is there a co-pay? If so, what? _______

Is there a maximum dollar amount that the company pays per year?
If so, what? ______


4. X-rays – Codes 72050, 72020, 72100, 72040

 

What is the coverage:
Is there a maximum number of visits? If so, how many?_____

Is there a deductible? If so,how much?______

Has any of the deductible been met? _____
If there is a deductible, what percentage will the

company pay versus myself ______________
(Example: 80% company / 20% patient)


Is there an Out of Pocket maximum? If so, what?___________

After this amount, the company will usually pay at 100%

Or instead of a deductible is there a co-pay? If so, what? _______

Is there a maximum dollar amount that the company pays per year?
If so, what? ______


5. Durable Medical Equipment – Codes A9300, E0190

 

What is the coverage:
Is there a maximum number of visits? If so, how many?_____

Is there a deductible? If so,how much?______

Has any of the deductible been met? _____
If there is a deductible, what percentage will the

company pay versus myself ______________
(Example: 80% company / 20% patient)


Is there an Out of Pocket maximum? If so, what?___________

After this amount, the company will usually pay at 100%

Or instead of a deductible is there a co-pay? If so, what? _______

Is there a maximum dollar amount that the company pays per year?
If so, what? ______


6. The patient will be having multiple treatments; 2-3 times per day

Will the company pay on the multiple treatments?

 

1 week Intensive Care

Available for patients with spinal curvatures 0-25º
98941 – 14 units
97012 – 40 units
97140 – 14 units
97110 – 36 units
99203 – 1 unit
99213 – 2 units
72040 – 1 unit
72050 – 1 unit
72020 – 2 units
72100 – 1 unit
72069 – 2 units

Equipment codes
A9300
E0190

2 week Intensive Care

Available for patients with spinal curvatures >25º 
98941 – 30 units
97012 – 74 units
97140 – 28 units
97110 – 76 units
99203 – 1 unit
99213 – 2 units
72050 – 1 unit
72020 – 3 units
72100 – 1 unit
72069 – 2 units
72040 – 2 units

Equipment codes
A9300
E0190
99070 (scoliosis traction chair)

42 visit Expanded Care

Available for patients
with any amount of
spinal curvature
98941 – 42 units
97012 – 42 units
97140 – 42 units
97110 – 84 units
99203 – 1 unit
99213 – 3 units
72050 – 1 unit
72020 – 3 units
72100 – 1 unit
72069 – 2 units
72040 – 2 units

Equipment codes
A9300
E0190