Useful Links

Key Resources for Prior Authorization and Appeal Requests for SpaceOAR® Hydrogel

Augmenix, Inc. and your dedicated Field Reimbursement Manager are committed to working with you (Provider and Facility) to navigate through the Payer Prior Authorization and Appeal processes, in order to achieve patient access for the SpaceOAR Hydrogel System.

Enclosed below, please find the recommended key supporting documents to assist you in the Prior Authorization or Appeal Process for SpaceOAR (CPT 55874).

In addition to including the patient medical records, patient lab reports and the key supporting documentation with each request, you can find SAMPLE Template Payer Letters for customization and additional resources on this page.  Please feel free to use these letters as a starting guide, to create one that works well for you – that you would be able to use as a “template” and then customize for each patient.

Recommended Paperwork for Prior Authorization and Appeal Requests for SpaceOAR hydrogel:

Reimbursement Contact Form

Fill out the form below to get in touch with a member of our reimbursement team.