Reimbursement

Clinical Efficacy and Favorable Reimbursement

Hologic recognizes the variable healthcare landscape and the impact on healthcare policy, physician and hospital utilization, and patient access. Hologic has dedicated internal and external resources focused on women’s health and access issues to support you.

Read below to find educational programs, reimbursement guides, and other resources to assist with coding, coverage, and reimbursement for our products.

Reimbursement support

With every new service you add, there will undoubtedly be questions that arise with regards to coding, billing and claims. Our reimbursement hotline is an exclusive tool available to Hologic customers at no additional cost. The hotline can assist you with:

  • Billing issues
  • Coding
  • Coverage
  • Contracted rate verification
  • Patient benefit verification
  • Patient pre-authorization/pre-certification
  • Claims appeals and denials
  • Low claims payment

Contact our Reimbursement Hotline

Monday- Friday 8:30AM-5:30PM EST
866.369.9290
hologic@thepinnaclehealthgroup.com

Medical policy coverage and payment

The Hologic health economics team works closely with commercial insurance companies, Medicare, and Medicaid to ensure positive coverage and ultimately to ensure reimbursement for our products.

Contracted rate verification

Our health economics team and reimbursement hotline can help navigate fee schedule information to clarify correct reimbursement rates for each procedure and location of service.

Pre-certification/pre-authorization for patient procedures

The reimbursement hotline can assist new accounts to pre-certify patients when starting to perform procedures.

Reimbursement and CPT Codes*

CPT Code

 

CPT Code Description

58558

 

58561

 

58559

 

58555

 

*American Medical Association (AMA), 2017 Current Procedural Terminology (CPT), Professional Edition. CPT codes and descriptions only are copyright 2016 AMA. All rights reserved. The AMA assumes no liability for data contained herein. No fee schedules, basic units, relative or related listings are included in CPT. Applicable FARS/DFARS Restrictions Apply for Government Use. Centers for Medicare & Medicaid Services (CMS), 2017 Healthcare Common Procedure Coding System (HCPCS) codes, available at http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.  AMA, 2017 CPT, Professional Edition.

 

Hologic provides this coding guide for informational purposes only. This guide is not an affirmative instruction as to which codes and modifiers to use for a particular service, supply, procedure or treatment. It is the provider’s responsibility to determine and submit the appropriate codes and modifiers for any service, supply, procedure or treatment rendered. Actual codes and/or modifiers used are at the sole discretion of the treating physician and/or facility. Contact your local payer for specific coding and coverage guidelines. Hologic cannot guarantee medical benefit coverage or reimbursement with the codes listed in this guide.