Prescribing & Practice Reimbursement Guide

How To Prescribe uresta®

Submit Your e-Prescription By Choosing 1
of These Easy Steps:

  1. If you use SureScripts please choose American Mail Order Pharmacy under the
    retail section or you can type in American Mail Order Pharmacy to find them.
  2. You can also look them up by their phone number: (586)-772-6872, by their address:
    23290 Schoenherr, Warren, MI 48089, or by their NCPDP #2370269
  3. You can fax the prescription to (586)-772-6873
  4. Call the prescription in to (586)-772-6872

Practice Reimbursement​

Coding Information for the 1500 Form*

Procedure codes**

  • Fitting and Insertion of the uresta® Pessary: 57160*​
  • OR Office Visit: For Example: 99214 (with the appropriate ICD.9 Diagnosis codes)​
  • Evaluation and Management codes may be used for subsequent uresta® follow-up visits.
    The amount of the charge is determined by the amount of time actually spent with the patient and whether this is a new or established patient.​
  • Procedure Code for Vaginal Irrigation: 57150​

HCPCS Code for a Pessary

  • A4562 – Pessary, non rubber, latex-free any type (i.e., Silicone pessary)​

For billing assistance or questions, please contact your local carrier.

*Note: Reimbursements may vary depending on region of the country
**May be able to bill for both on initial visit; consult your local carrier.