Reimbursement Information
Thank you for purchasing Össur products. Because we recognize that our customers may need billing assistance for our products and to support you, we have created a Billing Tool Kit.
Although it is designed primarily for Össur knee braces, you may find useful documentation for general billing here. The guidelines, forms, samples of completed documents and other billing tools below are designed to meet the strictest documentation requirements. You are welcome to adapt the master forms as your own or simply use them as a guide.
We are always at your service. If you have any questions about reimbursement of Össur products, now or in the future, please do not hesitate to contact your local sales representative or customer service representative.
Billing Tool Kit
Completed Billing Forms - Examples
Sample - RX, Medical Necessity and Detailed Written Order (40kb pdf)
Sample - Physician Chart Note (Treatment Plan) (26Kb doc)
Sample - Proof of Delivery (46Kb pdf)
Sample - Fitting Notes (39Kb pdf)Blank Billing Forms
Unloader One®, Medical Necessity and Detailed Written Order (51Kb pdf)
Ligament RX, Medical Necessity and Detailed Written Order (36Kb pdf)
Proof of Delivery and Warranty (35Kb pdf)
Fitting Notes (25Kb pdf)
PDAC Letters
Medicare PDAC Approval Letter - CTi Off-the-Shelf Knee Brace
Medicare PDAC Approval Letter - Paradigm Off-the-Shelf Knee Brace
Medicare PDAC Approval Letter - Flex Off-the-Shelf Knee Brace
Medicare PDAC Approval Letter - Flex Sport Off-the-Shelf Knee Brace
Medicare PDAC Approval Letter - 180 Off-the-Shelf Knee Brace
SADMERC Letters (Statistical Analysis Durable Medical Equipment Regional Carrier Letters)
AFO Dynamic (551Kb pdf)
Unloader ADJ (Custom Fabricated) (342Kb pdf)
Unloader Select (Custom Fabricated) (342Kb pdf)
Unloader Spirit (Prefabricated) (342Kb pdf)
Unloader Express (Prefabricated) (342Kb pdf)
Unloader (Non-adjustable Custom) (44Kb pdf)