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These instructions only apply to patients living in the US. Patients living outside of the US will need to order from their local international distributor (https://www.passy-muir.com/international).
For a patient to order directly, Passy Muir requires: BOTH a written prescription from a doctor’s office AND the Passy Muir Prescription Verification Form to be filled out by a doctor’s office or medical facility. The written prescription and Prescription Verification Form may be sent through fax or email.
The written prescription must include the following information:
- Doctor’s Office/Medical Facility’s Shipping address (non-residential)
- Doctor’s Office/Medical Facility’s Contact information,
including phone number - Product Number, Quantity, and Refill Amounts
- Shipping requirements (Ground or Priority)
The Passy Muir Prescription Verification Form will be used in addition to the written prescription for verification purposes.
Please click here to download a prescription verification form.
PLEASE NOTE: If there is any missing or incomplete information on either of the documents, a Customer Service Representative will need to contact you for further clarification.
Shipping Policy
Since our products are prescription devices, we are prohibited from shipping our products to a patient’s home address or a P.O. Box. We can only ship to the doctor’s office/medical facility’s address listed on the written prescription.
Payment
The patient will be contacted for payment after the prescription is verified. The patient will need to pay out-of-pocket; we do not accept medical insurance as a form of payment. However, we can provide the HCPCS Prosthetic Billing Code for our products that may be submitted to an insurance provider for possible reimbursement. Please see below for details.
Refund Policy
Passy Muir products are prescription devices; therefore, our products are neither returnable nor exchangeable.
Insurance Coverage & Reimbursement
Passy Muir does not accept medical insurance as a form of payment. However, we provide HCPCS Prosthetic Billing Codes for our products that may be submitted to an insurance provider for possible reimbursement.
- HCPC Prosthetic code is L8501 for Valves
- HCPC Prosthetic code is E1399 for Adapters and Secure-Its
If questions, or for more information, please give us a call: 1 (800) 634-5397 Toll Free.
