Reimbursement has never been easier.
Privately Insured Patients
Handles communications with you patient's private insurance pharmacy benefit
Once approved, Solesta will be shipped directly to your office
- Your practice assumes no financial risk for product acquisition
Seeking reimbursement for any product can be a time-consuming process for you and your office staff. When it comes to product reimbursement for Solesta, we’re here to help.
Simply fill out the Patient Enrollment Form - for our expert assistance.
The Solesta Reimbursement Assistance Program minimizes barriers that delay or prevent access to Solesta and provides personalized reimbursement support to you and your patients. Call 1-877-546-7150 or email firstname.lastname@example.org for more information.
Important 2020 CPT Code Updates
Coding and Billing Instructions for CMS Form 1500
Effective January 1, 2020
Deleted CPT Code: 0377T
- Anoscopy with directed submucosal injection of bulking agent for fecal incontinence, using products such as NASHA/Dx (Solesta)
As of January 1, use CPT Code 46999
- Unlisted procedure, anus
- CPT code 46999 is a Category 1, permanent code, used for multiple miscellaneous/unlisted procedures
The HCPCS code for Solesta remains the same:
HCPCS Code: L8605
- Injectable bulking agent, dextranomer, hyaluronic acid copolymer implant, anal canal, 1 ml
Example of Medicare Local Coverage Determination (LCD) for Solesta
The remaining 11 Medicare carriers have not yet published formal LCDs, but they are providing coverage for Solesta on a case-by-case basis, with the written policy at the link above serving as a strong precedent for coverage of use of the product within the FDA-Approved Indications for Use (IFU).
Example of Private Payer Coverage Policies for Solesta
The Solesta Reimbursement Assistance Program is actively tracking coverage polices for other private payers and has been very successful in securing coverage on a patient-specific bases.
For further information, please contact the Solesta Reimbursement Assistance Program: