Zimmer® Patient Specific Instruments
Patient Specific Instruments Reimbursement Kit resources:
- Download Complete Zimmer® Patient Specific Instrumentation Reimbursement Kit PDF
- Sample Insurance Verification Form
- Sample Advanced Beneficiary Notice of Noncoverage Form
- Sample Consent Form for Commercial Patients for Non-Covered Services
- PSI Sample Letter of Prior-Authorization Request and Medical Necessity
- PSI Sample Letter of Medical Necessity
- PSI Sample Prior Authorization Appeal Letter
- PSI Sample Appeal Claims Denial Letter
Zimmer® Patient Specific Instruments - Disclaimer
The information presented in this reimbursement kit is intended for informational purposes only, and nothing herein is advice, legal advice or a recommendation of any kind, and it should not be considered as such. The coding and coverage information in this reimbursement kit was obtained from third party sources and is subject to change without notice, including as a result in changes in reimbursement laws, regulations, rules and policies. Reimbursement kit content is informational only, general in nature, and does not cover all situations or all payers' rules or policies, and is not intended to apply to any care of the patient to support reimbursement. Providers should report the procedure and related codes that most accurately describe the patient's medical condition, procedures performed and the products used. The information presented in this reimbursement kit represents no promise or guarantee from Zimmer regarding coverage or payment for products or procedures by Medicare or other payers.
Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to the hospital's Medicare part A fiscal intermediary, the physician's Medicare part B carrier, the applicable Medicare administrative contractor, or to appropriate payers. Zimmer specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information presented in this reimbursement kit. Additionally, the information provided in this reimbursement kit should not be misconstrued as advertising or promotion. Zimmer neither promotes nor advocates off-label use of any Zimmer product. Please consult the product literature supplied with Zimmer products to determine intended use.
This Reimbursement Kit is effective December 1, 2009
