Ordering an External Bone Growth Stimulator

Follow the instructions below to order...

Patients that Qualify:

1.  Failed fusion, where a minimum of 9 months has elapsed since the last surgery;

2.  Previous fusion at same level

 

3.  Multiple level fusion - A multiple level fusion involves 3 or more vertebrae (e.g., L4-S1)

***Medicare Patients are allowed one (1) bone growth stimulator in a five (5) year period***

CMF Script

Required Documentation to Authorize:

1.  Script that includes Provider NPI, Date, & Signature.  A practice script can be used or the CMF script below.

    

2.  Patient Demographics  that includes demographics and insurance information.

 

3. Chart Notes/Op Report including ICD-10, Surgery Date, Physician Signature.  Under treatment plan please dictate...

“Ordering spinal bone growth stimulator for assistance with the healing process given________________. ie: the patient risk factors, multi-level fusion, failed fusion, or repeat single level fusion”.  

Options to Submit Order:

1.  Fax required documentation to 602-391-2622 

2.  Email required documentation to bonestim@optimasurgical.com

 

3.  Upload required documentation online with the File Upload Tool