Prescribing & Practice Reimbursement Guide

Using Your uresta® Fitting Kit

  1. Request Your Fitting Kit. Our Fitting Kits contains 3 sizes – 3, 4, & 5 which are stamped
    into the handle of each uresta®.

  2. Fit a patient and dispose of the uresta®(s) used.

  3. Prescribe to our online pharmacy (see info below). Once prescribed to our Pharmacy
    your patient will receive a brand new kit with the 3 sizes that you have in your fitting kits.

  4. Contact us at to have your kits replenished at no charge.

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. Use our convenient Pre-Printed prescription pads to Fax a 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.