Sample Summary of Benefits

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Lexiscan

Lexiscan Product Box

Reimbursement Services
Benefit Verification
Benefit Verification Process

Sample Summary of Benefits

Benefit Verification Q & A
Prior Authorization
Prior Authorization Assistance Process

Sample Summary
of Benefits
Billing and Claims Assistance
Coding and Claims Processing

Overview of Required Documentation for Lexiscan

Relevant Codes for Lexiscan

Quarterly Coding and Billing Reference Sheets

CMS-1500 Completion Guide

Sample CMS-1500 Claim Form

CMS-1450 Completion Guide

Sample CMS-1450 Claim Form

Claims and Billing Assistance Process

Appealing Claims

Billing and Claims
Q & A

Sample Summary of Benefits

Call 1-800-477-6472 to request a Benefit Verification and receive a faxed Summary of Benefits.

Download a Sample Summary of Benefits (PDF - 204K)

Sample Summary of Benefits

PLEASE SEE INDICATION AND IMPORTANT SAFETY INFORMATION HERE.
PLEASE SEE FULL PRESCRIBING INFORMATION HERE.

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