Pertinent Medical Record Information for Medicare
Fax the following information to our office

Fax: 763-588-0066 Tel: 800-322-4461

Medical Record Information Requirements

Based on information from:

The Medicare Coverage lssues Manual (ClM) Section 6A-24, Non-lmplantable Pelvic Floor Electrical Stimulator, Permits coverage for non-implantable pelvic floor electrical stimulators for the treatment of:

  • Stress and / or Urge Urinary Incontinence or Fecal Incontinence
  • In cognitively intact patients
  • Who have failed a documented trial of pelvic floor muscle exercise training*

*A failed trial of pelvic muscle exercise training is defined as no clinically significant improvement in urinary incontinence after completing four weeks of an ordered plan of pelvic muscle exercises designed to increase periurethral muscle strength.

Please call us at 800-322-4461 if you have any questions.

Thank you.