ORTHOVISC Reimbursement Brochure

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HCPCS Code J7324

The reimbursement material in this document is provided for information purposes only

and represents no statement, promise or guarantee by DePuy Mitek, Inc. concerning

levels of reimbursement, payment or charge. It is not intended to increase or maximize

reimbursement by any payer. Providers are advised to consult their local payer

organization with regard to local reimbursement policies.

J Code Source: Federal Register/Vol. 72, No. 227, pp 66774/Tuesday, November 27, 2007.

DePuy Mitek, Inc., 325 Paramount Drive, Raynham, MA 02767

© DePuy Mitek, Inc. 2009. All Rights Reserved.

Printed in the U.S.A. P/N 901050 Rev.A 04/09

For additional reimbursement support,

please contact ORTHOVISC®Line

Monday – Friday

9:00 a.m. to 8:00 p.m. ET

Phone: 1.866.633.VISC (8472)

Fax: 1.877.248.1182

For information on reimbursement for DePuy

Mitek medical device products contact:

Monday – Friday

9:00 a.m. to 8:00 p.m. ET

Phone: 1.877.744.5617

Fax: 1.800.305.5299

ORDERING INFORMATION

Physicians may order ORTHOVISC®

for Medicare or Private Pay injections

by contacting:

DePuy Mitek Customer Service: 1.800.382.4682

Monday – Friday

8:30 a.m. to 6:30 p.m. ET

Orders must be received prior to 6:00 p.m. ET

to guarantee same day shipping.

ORTHOVISC ®Line

Web-Based and Hotline Reimbursement Services

ORTHOVISC® is manufactured by

and is a registered trademark of

Anika Therapeutics, Inc.

Bedford, MA 01730

ORTHOVISCLine services will:

•Investigate patient insurance coverage and prior

authorization requirements

•Provide assistance with general coding and billing questions

•Assist with payor-specific claim submission requirements

•Evaluate claim denials and provide assistance with

appeals process

•Offer Patient Assistance Program to patients without

insurance coverage (financial qualifications required)

ORTHOVISC Reimbursement facts:

•ORTHOVISC is covered by Medicare in all 50 states

•ORTHOVISC is covered by most managed care plans

•DePuy Mitek offers established reimbursement programs to

assist your office with information about billing and coding

•HCPCS code J7324

ORTHOVISC ®Line Web Portal and National Reimbursement Map

www.orthoviscline.com

ORTHOVISC®Line

Reimbursement Services

Healthcare providers and office personnel have access to a knowledgeable

reimbursement professional through the ORTHOVISCLine toll-free hotline or

the ORTHOVISCLine Web Portal for assistance with general coding and

reimbursement questions related to the administration of ORTHOVISC

®

High Molecular Weight Hyaluronan.

Provides immediate access to:

•Submit benefits verification online

•Receive automated alerts on status of submissions

•Track patient referrals by prescribing physician

•View basic reports on claims submitted and processed

•Download frequently used forms, templates and patient brochures

•Patient Assistance Program website

•Quick links to helpful industry websites

The National Reimbursement Map for ORTHOVISC

has made getting the most updated reimbursement information faster

and more efficient. This interactive reimbursement map provides quick

and easy access to ORTHOVISC reimbursement coverage information

for Medicare, Medicaid and Private Payers in each state.

•Direct links to third party payers for information on their

reimbursement policies

•Instant state-specific access to Payer Medical Policies,

HCPCS Codes and Specialty Pharmacy information

•State-by-state breakdown of reimbursement coverage for:

- Medicare/Medicaid

- Private Payers

- Specialty Pharmacy

www.orthoviscline.com features the new ORTHOVISCLine

Web Portal for online patient insurance coverage verification

and the National Reimbursement Map for the most updated

reimbursement information by state. www.orthoviscline.com

offers easy online navigation providing 24/7 localized

ORTHOVISC® reimbursement information.

The ORTHOVISCLine Web Portal is a secure website that

offers healthcare professionals and office personnel the ability

to submit insurance benefits verification requests on-line.

This user-friendly web portal is accessible 24/7 and may help

you to streamline your ORTHOVISC reimbursement process.

ORTHOVISCLine

Hotline:

Monday – Friday

9:00 a.m. to 8:00 p.m. ET

Phone: 1.866.633.VISC (8472)

Fax: 1.877.248.1182

HCPCS Code J7324

The reimbursement material in this document is provided for information purposes only and represents

no statement, promise or guarantee by DePuy Mitek, Inc. concerning levels of reimbursement, payment

or charge. It is not intended to increase or maximize reimbursement by any payer. Providers are advised

to consult their local payer organization with regard to local reimbursement policies.

J Code Source: Federal Register/Vol. 72, No. 227, pp 66774/Tuesday, November 27, 2007.

For additional reimbursement support,

please contact ORTHOVISC®Line

Monday – Friday

9:00 a.m. to 8:00 p.m. ET

Phone: 1.866.633.VISC (8472)

Fax: 1.877.248.1182

For information on reimbursement for DePuy

Mitek medical device products contact:

Monday – Friday

9:00 a.m. to 8:00 p.m. ET

Phone: 1.877.744.5617

Fax: 1.800.305.5299

ORDERING INFORMATION

Physicians may order ORTHOVISC®

for Medicare or Private Pay injections

by contacting:

DePuy Mitek Customer Service: 1.800.382.4682

Monday – Friday

8:30 a.m. to 6:30 p.m. ET

Orders must be received prior to 6:00 p.m. ET

to guarantee same day shipping.

ORTHOVISC ®Line

Web-Based and Hotline Reimbursement Services

ORTHOVISC® is manufactured by and is a registered trademark of Anika Therapeutics, Inc.

Bedford, MA 01730

DePuy Mitek, Inc., 325 Paramount Drive, Raynham, MA 02767

© DePuy Mitek, Inc. 2009. All Rights Reserved.

Printed in the U.S.A. P/N 901050 Rev.A 04/09