Get Neurostar Tms Form

Filling out the NeuroStar Tms Form online can be straightforward with the right guidance. This guide will walk you through each section of the form to ensure that you provide the necessary information accurately and efficiently.

Follow the steps to complete the NeuroStar Tms Form online.

1. Press the ‘Get Form’ button to acquire the NeuroStar Tms Form and open it in your preferred editor.
2. Fill out the TMS Physician Information section by providing your name, NPI number, tax ID number, facility or practice name, address, city, state, zip code, phone number, and fax number. Ensure that all fields are completed fully.
3. Provide the TMS Coordinator and other key reimbursement contact information in the designated fields.
4. Indicate whether your office is contracted with the insurance, and if a secondary plan exists.
5. In the Patient Information section, enter the patient’s name, date of birth, and address. Include their home, work, and cell phone numbers.
6. Attach a copy of the patient’s insurance card(s) when completing the Patient Insurance Information. Fill out the primary and secondary insurance details, including the subscriber's information and the relationship to the subscriber.
7. In the Patient Authorization section, the patient must sign and date the form, indicating consent for information disclosure related to their health and treatment.
8. Check the relevant procedural (CPT) and diagnosis (ICD-9) codes that apply to the patient’s case and indicate the anticipated number of TMS sessions.
9. Specify the site of service for treatment from the provided options.
10. Complete the Physician Certification section with the physician's full signature and date, confirming the information is accurate and authorizing Neuronetics to obtain necessary reimbursement.
11. Review the Patient Enrollment Checklist to ensure all sections are completed, including required signatures. Save your changes, download, print, or share the form as needed.

Take action today and complete the NeuroStar Tms Form online.