The Centers for Medicare & Medicaid Services (CMS) released 25 corrections to the 2012 HCPCS Level II ANWEB file. The corrections, released Jan. 30, include description and ambulatory surgery center (ASC) indicator changes, removal of codes, updated Berenson-Eggers Type of Service (BETOS) information, and revised effective dates.
Terminated or Removed
C9716 Creations of thermal anal lesions by radiofrequency energy should be terminated effective Jan. 1, 2012.
G0449 Annual face-to-face obesity screening, 15 minutes will not be created. Remove from file.
G0450 Screening for sexually transmitted infections, includes laboratory tests for chlamydia, gonorrhea, syphilis and hepatitis B will not be created. Remove from file.
G0446 Long description Intensive behavioral therapy to reduce cardiovascular disease risk, individual, fact-to-face, >annual<, 15 minutes is revised effective Nov. 8, 2011.
G8553 Both short description (Prescrip transmit via ERx sy) and long description (Prescription(s) generated and transmitted via a qualified ERx system) are changed effective Jan. 1, 2012.
J1561 Short description Gamunex, Gamunex-C, Gammaked is changed effective Jan. 1, 2012.
Revised Effective Dates
G0442 Annual alcohol misuse screening, 15 minutes is now effective Oct. 14, 2011.
G0443 Brief face-to-face behavior counseling for alcohol misuses, 15 minutes is also effective Oct. 14, 2011.
K0743 Suction pump, home model, portable, for use on wounds is now effective July 1, 2011.
C1886 Catheter, extravascular tissue ablation, any modality (insertable)—Add ASC “YY” indicator, effective Jan. 1, 2012.
C9728 Placement of endorectal intracavitary applicator for high intensity brachytherapy—Add ASC “YY” indicator, effective Jan. 1, 2008.
C9732 Insertion of ocular telescope prosthesis including removal of crystalline lens—Add ASC “YY” indicator, effective Jan. 1, 2012.
G0448 Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing—Change TOS to “2,” effective Jan. 1, 2012.
J2265 Injection, minocycline hydrochloride, 1 mg—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4123 Alloskin RT, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4125 Arthroflex, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4126 Memoderm, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4127 Talymed, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4128 FlexHD or Allopatch HD, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
Q4129 Unite biomatrix, per sq cm—Remove ASC “YY” indicator, effective Jan. 1, 2012.
J8561 Everolimus, oral 0.25, mg—Change BETOS to “01E,” effective Jan. 1, 2012.
CMS recommends updating data files as well as noting changes in codebooks.
February 10th, 2012
The July update to the Center for Medicare & Medicaid Services’ (CMS) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule includes codes added retroactively to Jan. 1, 2011, as well as new suction pump and oxygen codes, and new proof-of-delivery requirements.
The significant changes to Medicare policy include the addition of fees for the following codes, retroactive to claims on or after Jan. 1, 2011. These national fees replace the local fee schedule payments. Contact your payer to have the claims already processed for this year adjusted. Claims after July 1 will be automatically paid under the new fee schedule.
- A7020 Interface for cough stimulating device, includes all components, replacement only
- E1831 Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
- L5961 Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control
Effective July 1, the following codes can be reported based on the DMEPOS fee schedule:
- K0743 Suction pump, home model, portable, for use on wounds
- K0744 Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less
- K0745 Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches
- K0746 Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches
Code E0571 Aerosol compressor, battery powered, for use with small volume nebulizer will become invalid for Medicare claims effective July 1.
Code A4619 Face tent is being revised to move this nebulizer accessory from the Oxygen Supplies category to the category for Inexpensive & Routinely Purchased DME, effective July 1.
There are also adjustments to how oxygen will be paid this quarter.
Payment for both oxygen contents used with stationary oxygen equipment and oxygen contents used with portable oxygen equipment is included in the monthly payments for oxygen and oxygen equipment (stationary oxygen equipment payment) made for codes E0424, E0439, E1390, or E1391. After the 36-month rental payment period (cap), separate payment may be made for oxygen contents for the remainder of the equipment’s reasonable useful lifetime. However, separate payment for oxygen contents ends when replacement stationary oxygen equipment is furnished, causing a new 36-month rental payment period to begin. Also, separate oxygen contents payment is allowable for beneficiary-owned stationary or portable gaseous or liquid oxygen equipment. Beginning with dates of service on or after the service’s end date for the month representing the 36th stationary oxygen equipment payment (codes E0424, E0439, E1390, or E1391), a supplier may bill on a monthly basis for furnishing oxygen contents (stationary and/or portable), but only in accordance with the following chart:
|Oxygen Equipment Furnished in
|Monthly Contents Payment after the Stationary Cap
|Oxygen Concentrator (E1390, E1391, or E1392)
|Portable Gaseous or Liquid Transfilling Equipment (K0738 or E0433)
|E0424 Stationary Gaseous System
||E0441 Stationary Gaseous Contents
|E0439 Stationary Liquid System
||E0442 Stationary Liquid Contents
|E0431 Portable Gaseous System
||E0443 Portable Gaseous Contents
|E0434 Portable Liquid System
||E0444 Portable Liquid Contents
Also, the new fee schedule outlines the proof-of-delivery requirements for oxygen contents, as the supplier is responsible for ensuring that the beneficiary has a sufficient quantity of oxygen contents and is never in danger of running out of contents. A maximum of three months of oxygen contents can be delivered to the beneficiary at one time and billed on a monthly basis. In these situations, the delivery date of the oxygen contents does not have to equal the date of service (anniversary date) on the claim, but to bill for contents for a specific month (i.e., the second or third month in the three-month period), the supplier must have delivered quantities of oxygen that are sufficient to last for one month following the date of service on the claim. Suppliers should have proof of delivery for each actual delivery of oxygen, which may be less than monthly within the three-month period. If the supplier delivers more than one month of oxygen contents at a time (2 to 3), the supplier is not entitled to payment for additional months 2 and 3 if medical need ceases before the date when the supplier would be entitled to bill for those months.
There is much, much more to this update. Be sure to investigate CMS Transmittal 2236, Change Request (CR) 7416, issued June 3. If you continue to have questions, contact your payer to ensure you clearly understand these policy changes.
June 10th, 2011
The Centers for Medicare & Medicaid Services (CMS) has introduced four new HCPCS Level II K codes for use by providers and suppliers who bill Parts A and B Medicare administrative contractors (A/B MACs) or durable medical equipment contractors (DME MACs) for suction pumps and accompanying surgical dressings to Medicare beneficiaries:
K0743 Suction pump, home model, portable, for use on wounds
K0744 Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less
K0745 Absorptive wound dressing for use with suction pump, home model; portable, pad size more than 16 square inches but less than or equal to 48 square inches
K0746 Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 inches
Suction pumps and wound dressings of these types are used during negative wound pressure therapy.
All codes are effective July 1; however, they have been assigned a “C” coverage status (Carriers will establish relative value units (RVUs) and payment amounts for these services, generally on an individual case basis following review of documentation, such as an operative report). As such, Medicare payment is not guaranteed. Only RVUs associated with status codes of “A,” “R,” or “T” are used for Medicare payment.
For additional information, see MLN Matters® article MM7411 and related Change Request (CR) 7411.
May 5th, 2011