Reimbursement Support

Welcome to Premia Spine’s suite of reimbursement resources. The resources below are intended to provide assistance with procedure coding, pre-authorization, benefit verification, and claims.

Coding and Payment Guides

• TOPS System Reimbursement Guide
• TOPS System Hospital Coding Quick Reference
• TOPS System Physician Coding Quick Reference

Benefit Verification and Prior-Authorization

• TOPS System Prior Authorization – Quick Reference
• TOPS System Letter of Medical Necessity – Template
• TOPS System Prior Authorization 1st Level Appeal – Template
• TOPS System Prior Authorization 2nd Level Appeal – Template

Claims Resources

• TOPS System CMS Form 1500 – Example
• TOPS System Special Report_Scenario 1
• TOPS System Special Report_Scenario 2
• TOPS System Special Report_Scenario 4

TOPS System Patient Access Support

• Patient Access Support – Introduction
• TOPS Medical Information Release Form
• TOPS Patient Access Program Provider Request Form

Clinical Evidence

• Publication Listing

PLEASE NOTE:
Reimbursement information provided by Premia Spine is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Premia Spine encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Premia Spine recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Premia Spine does not promote the use of its products outside their FDA-approved label.