Tirosint-SOL Reimbursement Guide

IBSA Pharma Inc. has developed this resource to support healthcare professionals (HCPs) navigate coverage, coding, and insurance coverage for Tirosint®-SOL (levothyroxine sodium) oral solution. The information in this Reimbursement Guide is intended solely as a resource to assist the staff in physicians’ offices with certain insurance-related questions for Tirosint®-SOL.

Sample Letters of Medical Necessity and Appeal for Insurance Provider

Provided below are downloadable templates to reference and utilize at your convenience for insurance providers on behalf of Tirosint-SOL. These are not to be sent as is, fill in patient information as needed since these are not complete letters.

ICD-10 Codes

To see the full list of ICD-10 codes, click the button below

Procedure Notes Forms