REIMBURSABLE SINCE 2004

THE ARTASSIST DEVICE MAY BE REIMBURSABLE UNDER HCPCS CODE E0675, PNEUMATIC COMPRESSION DEVICE

Note: ACI Medical is NOT a provider and cannot bill insurance on your behalf.
 

ACI Medical does not handle the reimbursement process between the patient and insurance company. We are the manufacturer of the ArtAssist® device and do not have a provider code to bill insurance companies; however, we would be more than happy to answer any questions you may have. It is also up to the carrier's discretion whether the patient receives a reimbursement.

Because the reimbursement process is typically lengthy and requires time, patients must pay for rental costs and then submit a claim to try and obtain reimbursement.

Reimbursement Steps for Medicare...

  1. Complete Form 1490 - Patient's Request for Medical Payment. Be sure to carefully follow instructions.
  2. Submit a physican's certificate of medical necessity. This is a letter from your physician describing your need for the ArtAssist® device in your particular case. Include any copies of vascular tests, photos or documentation showing your condition.
  3. Include a description of the ArtAssist® device and any product literature.
  4. Include the Medicare letter dated January 29, 2004.
  5. Include the Social Security Administration Care Report from the Office of Hearings and Appeals.
  6. Send copies of the sales receipt(s).

* Mail to the DME Regional Carrier in your area. (See below).
* Be sure to send copies; keep the originals for your records.

For additional information, please call your Durable Medical Equipement Regional Carrier in your area.
         
Regional Carrier
States
Telephone No.
Address
 
AdminaStar Federal Inc.
DC IL IN MD MI MN OH VA WI WV
877-299-7900
PO Box 240
Indianapolis, IN 46206
 
CIGNA TN Call Center
AK AS AZ CA GU HI IA ID KS MO MT ND NE NV OR SD UT WA WY
877-320-0390
 PO Box 690
Nashville, TN 37202
 
Health Now DMERC Call Center
CT DE MA ME NH NJ NY PA RI VT
866-419-9458
PO Box 6800
Wilkes-Barre, PA 18773
Palmetto GBA
AL AR CO FL GA KY LA MS NC NM OK PR SC TN TX VI
800-583-2236
 PO Box 100141
Columbia, SC 29202
ACI cannot accept liability for any errors in your submission, and you agree to this by accepting this information and using it as a guide.
ArtAssist®, VenAssist®, VenaPulse®, and APG® are register trademarks of ACI Medical, LLC, San Marcos, CA, USA.