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Advisory Articles

Advisory Articles Articles

Billing of Powered L-Coded Items - Correct Coding - Revised L1690 Prefabricated Bilateral Lumbo-sacral Hip Orthosis - Correct Coding L1005 - Tension Based Scoliosis Orthosis and Accessory Pads, Includes Fitting and Adjustment - Correct Coding Retired - Correct Coding - MyoPro (Myomo, Inc.) Assist Device - Revised Parenteral Nutrition - Correct Coding and Billing Retired - Correct Coding - Powered Exoskeleton Products Enteral Nutrition - Correct Coding and Billing L1686 Prefabricated Hip Abduction Orthosis - Correct Coding Retired - Correct Coding and Coverage of Ventilators – Revised April 2019 Scoliosis Brace - Correct Coding Retired - Correct Coding and Coverage - Panzyga® (Immunoglobulin Intravenous (Human), 10%)Correct Coding - U 500 Insulin for Use in External Insulin Infusion Pumps HCPCS CODE UPDATE – 2011 Correct Coding – 2019 HCPCS Code Annual Update - Corrected HCPCS Code Update- 2009 Correct Coding for Items Used to Treat Edema - Revised Prosthetic Feet and Additions to Lower Limb Extremity Prostheses - Correct Coding and Coding Verification Review Requirement Continuous Glucose Monitor Supplies - Correct Coding and Billing KF Modifier Use - Correct Coding Panzyga® (Immunoglobulin Intravenous (Human), 10%) Correct Coding and Coverage - Revised 2020 HCPCS Code Annual Update - Correct Coding - Revised Incorrect Use of HCPCS Code A9279 - Correct Coding Correct Coding - Articulating Digit(s) and Prosthetic Hands - Revised Partial Hand Prostheses - Correct Coding New HCPCS Code - Revefenacin (Yupelri®) - J7677 ENTERAL NUTRITION SUPPLY KITS - B4034-B4036 ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER – CODING VERIFICATION REVIEW REQUIREMENT HCPCS CODE A9283 – DEVICES USED FOR EDEMA OR ULCER HEALING ORAL ANTI-CANCER DRUGS – CODING AND BILLING CHANGE TRANSCUTANEOUS ELECTRICAL NERVE STIMULATORS (TENS) SOLD OVER-THE-COUNTER – CODING GUIDELINES CODING GUIDELINES FOR THERAPEUTIC SHOES FOR PERSONS WITH DIABETES HCPCS CODE UPDATE – (2014)Retired - Correct Coding for Pneumatic Compression Devices MULTIPLE COPIES OF APPLICATIONS NOT NEEDED CORRECT CODING AND BILLING OF CANTILEVER TYPE ARMREST CLARIFICATION OF BILLING SURGICAL DRESSINGS AS COMPONENTS OF KITS CORRECT CODING – SAFETY EQUIPMENT PACKAGES WITH POWER OPERATED VEHICLES (POVS)HCPCS CODE E0571 - INVALID Retired - Ankle-Foot Orthoses – Arizona-Type – Correct Coding FUNCTIONAL ELECTRICAL STIMULATORS – NEW CODE PDAC CONTRACT EFFECTIVE AUGUST 18, 2008 HCPCS CODE UPDATE - (2010) - REVISED TRACHEOSTOMY CARE KIT - CODING GUIDELINES BILLING FOR CAPECITABINE (XELODA®) 500 MG DOSAGE FORM – EUROPEAN FORMULATION BLISTER PACK Power Mobility Device Independent Testing Requirements REVISED – POWER MOBILITY DEVICE INDEPENDENT TESTING REQUIREMENTS HCPCS CODE UPDATE – 2012 HCPCS CODE UPDATE – 2013 REMINDER - ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER – CODING VERIFICATION REVIEW REQUIREMENT CORRECT CODING – SURGICAL DRESSINGS CONTAINING MEDICAL HONEY CORRECT CODING – SUPPLIES USED WITH E0446 – JOINT DME MAC PUBLICATION SPEECH GENERATING DEVICE – INFORMATION REQUIRED FOR CODING VERIFICATION REVIEW REVISED – POWER MOBILITY DEVICE INDEPENDENT TESTING REQUIREMENTS EFFECTIVE OCTOBER 1, 2015 RETIRED – CORRECT CODING – CEFALY®SPEECH GENERATING DEVICES – CODING VERIFICATION REVIEW REQUIREMENT – UPDATE Retired - Correct Coding - Lithium Batteries - Updated BREATHE NIOV™ - CODING REMINDER – REVISED JANUARY 2014 NEW OFF-THE-SHELF ORTHOTIC CODES Retired - Coverage and Correct Coding of Continuous Glucose Monitoring (CGM) Devices - Revised CORRECT CODING – DRUGS AND FLUIDS CORRECT CODING – DIATHERMY AND BIOFEEDBACK DEVICES Retired - Coverage and Correct Coding of Continuous Glucose Monitoring Devices CORRECT CODING – SURGICAL DRESSINGS CONTAINING NON-COVERED COMPONENTS CORRECT CODING – ORAL ANTICANCER DRUGS AND PDAC’S NDC/HCPCS CROSSWALK LISTINGS CORRECT CODING – 2016 HCPCS CODE ANNUAL UPDATE COVERAGE REMINDER – SPEECH GENERATING DEVICES Retired - Correct Coding - Negative Pressure Wound Therapy (NPWT)CORRECT CODING – IDEO AND EXOSYM ENERGY STORING AFO Retired - Continuous Glucose Monitors - Frequently Asked Questions Retired - Correct Coding – NOC Codes for Enteral (B9998) and Parenteral (B9999) Nutrition CORRECT CODING – HYGIENIC CLEANSERS, DIAPERS, AND UNDER-PADS Retired - Coding and Coverage - Therapeutic Continuous Glucose Monitors (CGM)Retired - Speech Generating Devices – Coding Verification Review Requirement CORRECT CODING – HCPCS CODING RECOMMENDATIONS FROM NON-MEDICARE SOURCES Retired - Correct Coding - inFlow™ Intraurethral Valve-Pump (Vesiflo, Inc.)CORRECT CODING – DIAPERS AND UNDERPADS Retired - Correct Coding - Manual Wheelchairs Constructed of Titanium Retired - Correct Coding and Coverage of Ventilators – Revised May 2016 CORRECT CODING – 2017 HCPCS CODE ANNUAL UPDATE Retired - Correct Coding - 2019 HCPCS Code Annual Update Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Battery Charger Correct Coding - Warranty, Reasonable Useful Lifetime (RUL), and the Minimum Lifetime Requirement (MLR) for Durable Medical Equipment Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Wheelchair Tray Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for an Actuator Retired - Correct Coding - Q9994 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH) Coverage Indicator Changed Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Anti-Tip Devices for Manual Wheelchairs Retired - Correct Coding - Inserts Used with Therapeutic Shoes for Persons with Diabetes (A5512, A5513, K0903)Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Wheel Lock Brake Extension for Manual Wheelchairs Correct Coding – Incorrect Use of HCPCS Code K0108 To Bill for a Wheelchair Headrest Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Labor Charges Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Transit System and Associated Bracket Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Front Riggings: Shoe Holder or Shoe Holder Replacement Straps Continuous Glucose Monitors - Use of Smart Devices Topical Oxygen Therapy Used For Wound Care - An Update Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Battery Replacement Correct Coding – Replacement Cecostomy Tube Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Replacement of Wheelchair Seat and Back Upholstery Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Front Riggings: Calf Pad or Calf Support Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Privacy Flap Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Wheelchair Ventilator Tray Correct Coding - A9286 - Hygienic Item or Device, Disposable or Non-disposable, Any Type, Each Retired - 2020 HCPCS Code Annual Update - Correct Coding PDAC Coding Guidelines for Off-the-Shelf Diabetic Shoes (A5500)CORRECT CODING – INSULIN USED WITH CONTINUOUS EXTERNAL INSULIN INFUSION PUMPS Retired - Correct Coding and Coverage of Ventilators - Revised January 2019 HCPCS CODE L0430 - INVALID Retired - Correct Coding – “No-Touch” Catheters REVISED – COLLAGEN SURGICAL DRESSINGS – CODING VERIFICATION REVIEW REQUIREMENT K0009 MANUAL WHEELCHAIR – CODING VERIFICATION REVIEW REQUIREMENT Retired - Correct Coding Reminder - Duopa® (AbbVie)CORRECT CODING – WEIGHTLESS WALKER COVERAGE AND CORRECT CODING OF YONDELIS®Retired - Correct Coding – Center Mounted Elevating Leg Rest CORRECTION – NEW MODIFIER CS – EFFECTIVE DATE APRIL 20, 2010 CORRECT CODING – INTEGRATED RESPIRATORY PRODUCTS CORRECT CODING – BUZZY®Retired - Correct Coding - Not Otherwise Classified (NOC) HCPCS Codes Used for Drugs Retired - Correct Coding and Coverage of Ventilators Retired - Correct Coding and Coverage – Peristeen® Transanal Irrigation (PAI) System WALKER UNBUNDLING BILLING FOR BRAKES CORRECT CODING – VIBRATION THERAPY DEVICES CORRECT CODING INSTRUCTIONS – A4358 URINARY COLLECTION BAG CORRECT CODING – BEMER PHYSICAL VASCULAR THERAPY DEVICES POLICY ARTICLE REVISION – VACUUM ERECTION DEVICES (VED)CORRECT CODING – FITNESS MONITORING TECHNOLOGIES Retired - MyoPro™ - Coding Reminder CORRECT CODING OF CONTINUOUS PASSIVE MOTION DEVICES E0486 – CUSTOM FABRICATED ORAL APPLIANCE FOR OSA – CODING AND UTILIZATION GUIDELINES HCPCS CODE UPDATE – (2015)Retired - Correct Coding - Center Mount Elevating Leg Rest - Revised Correct Coding - Lithium Batteries - Revised Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Drive Wheel Gear Box CORRECT CODING AND COVERAGE – E0740 NON-IMPLANTABLE PELVIC FLOOR ELECTRICAL STIMULATOR L3960 - Coding Verification Review Requirement CORRECT CODING – LINERS USED WITH POSITIVE AIRWAY PRESSURE (PAP) MASK COVERAGE AND CORRECT CODING OF DUOPA® (LEVODOPA-CARBIDOPA ENTERAL SUSPENSION)CORRECT CODING REMINDER - MONITORING TECHNOLOGY USED WITH POSITIVE AIRWAY PRESSURE DEVICES (PAP) AND RESPIRATORY ASSIST DEVICES (RAD)Retired - Coverage and Correct Coding of Blincyto™ – Revised UROLOGICAL SUPPLIES – A4353 CORRECT CODING CLARIFICATION POLICY REVISION CORRECT CODING – TOBI® PODHALER™Retired - Correct Coding and Coverage - RELiZORB (Alcresta Therapeutics) In-Line Cartridge CORRECT CODING – ARGUS® II RETINAL PROSTHESIS SYSTEM K0009 MANUAL WHEELCHAIR – CODING VERIFICATION REVIEW REQUIREMENT – UPDATE CORRECT CODING – L0174 CODING REVIEW CORRECT CODING – CAST COVERS CORRECT CODING – ORAL APPLIANCES NOT USED FOR THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA CORRECT CODING AND COVERAGE – ORAL SUSPENSIONS USED IN THE TREATMENT OF ORAL MUCOSAL INJURIES CORRECT CODING – INTERFERENTIAL CURRENT (IFC) THERAPY DEVICES Retired - Correct Coding - Lithium Batteries CORRECT CODING – 2018 HCPCS CODE ANNUAL UPDATE K0009 MANUAL WHEELCHAIR – CODING VERIFICATION REVIEW REQUIREMENT – DEADLINE EXTENDED RESPIRATORY ASSIST DEVICES – E0472 Retired - Correct Coding – Pneumatic Compression Devices and Related Appliances – Revised Retired - Correct Coding - Otto Bock C-Leg Coding - Revised Retired - Correct Coding – Billing of Powered L-Coded Items Retired - Glucose Monitors LCD and Related Policy Article - Revised CORRECT CODING – FULL LENGTH ROCKER SOLES ADDED TO THERAPEUTIC SHOES CORRECT CODING – TRACHEOSTOMY TUBES CANTILEVER TYPE ARMREST – CORRECT CODING CODING GUIDELINE – K0900 (CUSTOM DURABLE MEDICAL EQUIPMENT, OTHER THAN WHEELCHAIRS)CORRECT CODING FOR ORAL APPLIANCES FOR THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA (E0486)CORRECT CODING – P-STIM® DEVICE Retired - Correct Coding and Coverage of Ventilators – Revised Effective January 1, 2016 COLLAGEN SURGICAL DRESSINGS – CODING VERIFICATION REVIEW REQUIREMENT REVISED – K0009 MANUAL WHEELCHAIR – CODING VERIFICATION REVIEW REQUIREMENT CONCENTRIC ADJUSTABLE TORSION JOINTS – CORRECT CODING WHAT IS THE DIFFERENCE BETWEEN THE PDAC AND THE DME MACS?Retired - Correct Coding - Articulating Digit(s) and Prosthetic Hands CORRECT CODING – SPEEDICATH® FLEX COUDÉ CATHETER (COLOPLAST)EXERCISE EQUIPMENT - CORRECT CODING REQUIREMENTS FOR CODING REVIEW OF CUSTOM FABRICATED SPINAL ORTHOSES Correct Coding - Porta-Lung Negative Pressure Ventilator - Revised CORRECT CODING INSTRUCTIONS – PORTA-LUNG® NEGATIVE PRESSURE VENTILATOR CORRECT CODING - APNICURE WINX® SLEEP THERAPY SYSTEM CORRECT CODING – HCPCS CODING OF SURGICAL DRESSINGS – COMPONENTS TO REPORT ON THE PDAC HCPCS CODE VERIFICATION APPLICATION HEIGHT STANDARDS FOR CODING LSO AND TLSO - REVISED CORRECT CODING – URINARY DRAINAGE TUBE ADAPTER CORRECT CODING – HYGIENIC ITEMS, WASH CLOTHS, AND CLEANSING WIPES Retired - Spinal Orthosis – Coding Verification Review Requirement Retired - Charcot Restraint Orthotic Walker - Crow Boot - Coding Retired - Charcot Restraint Orthotic Walker – Crow Boot – Coding Update Retired - Coding Instructions - Microprocessor Controlled Knee Prostheses Retired - Elastic Garments – Noncovered Retired - Correct Coding – LIM Innovations Infinite Socket™Retired - Pneumatic Knee Splint – Coding Verification Review Requirement Retired - LIM Innovation Infinite Socket - Correct Coding - Revised Retired - Correct Coding – LIM Innovation Below Knee Socket Retired - Correct Coding – LIM Innovations Infinite Socket™ – Revised Retired - Coding Guidelines for Ankle Foot Orthoses Retired - Revised - Coding Guidelines for Ankle-Foot Orthoses Retired - Submitting Diabetic Shoe Inserts for Coding Retired - Correct Coding Instructions – Endolite Echelon® Prosthetic Foot Correct use of Not Otherwise Specified L-codes for Orthoses and Prostheses - Billing Reminder Retired - Correct Coding - MyoPro® (Myomo, Inc.) Assist Device MyoPro® (Myomo, Inc.) Assist Device - Correct Coding - Revised Retired - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Revised Retired - Correct Coding – Definitions Used for Off–the–Shelf Versus Custom Fitted Prefabricated Orthotics (Braces) – Revised Retired - Correct Coding and Billing for Microprocessor-Controlled Knee Systems Retired - Correct Coding – Braces (Orthoses) Attached to Wheelchairs Retired - Appropriate Coding and Billing of Lower Limb Prosthetic Covers and Covering Systems Retired - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Revised Insulin Infusion Pumps with Integrated Continuous Glucose Sensing Capabilities and Related Accessories/Supplies – Codes E0787 and A4226 - Correct Coding Correct Coding and Coverage of Ventilators - Revised July 2020 Custom Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code - Correct Coding Retired - MyoPro® (Myomo, Inc.) Assist Device - Correct Coding - Revised Retired - Incorrect Use of HCPCS Codes for Custom Fit Orthotics Retired - Vacuum Erection Device – Coding Verification Review Requirement Ankle-Foot Orthoses - Arizona-Type - Correct Coding - Revised Retired - Correct Coding – Whill Model A Powered Personal Mobility Device Retired - Correct Coding – Billing of HCPCS Code E0986 Retired - Correct Coding – Bariatric Pressure Reducing Support Surfaces Retired - Correct Coding – Whill Powered Personal Mobility Devices – Revised Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Correct Coding - Revised Retired - Correct Coding – Ankle Orthoses, With or Without Joints, Prefabricated or Custom Fabricated Coding Verification Review Retired – Correct Coding – Martin Bionics Socket-Less Socket – Revised Retired - Hand-Finger Orthoses – Use of CG Modifier – Revised Retired - Hand Finger Orthoses (L3923) - Use of CG Modifier Correct Coding and Coverage – Braces Constructed Primarily of Elastic or Other Fabric Materials – Revised Retired - Correct Coding and Coverage – Braces Constructed Primarily of Elastic or Other Fabric Materials Retired - Correct Coding – Submitting Diabetic Shoe Inserts for HCPCS Coding – PDAC Coding Application Instruction Retired - Ankle-Foot Orthoses – Arizona-Type – Correct Coding – Revised Retired - Xembify® - Correct Coding Retired - Coverage and Correct Coding of Blincyto™Retired - Correct Coding – Eclipse™ Vaginal Insert System (Pelvalon, Inc.)Retired - Coverage and Coding – New Oral Antiemetic Drug Varubi™Retired – Correct Coding – Eclipse™ Vaginal Insert System (Pelvalon, Inc) - Revised Retired - Coverage and Coding – New Oral Antiemetic Drug Varubi® – Revised – Effective Date July 1, 2016 Retired - Coverage and Correct Coding of CUVITRU™Retired - Correct Coding – PRO-FLEX® Prosthetic Foot (Össur)Retired - Correct Coding – A5513 Product Coding Redetermination Project Retired - Correct Coding - PROSE ® Device Retired - Correct Coding - A5513 Custom Molding Requirements Correct Coding of CUVITRU™ - Revised Retired - Endoskeletal Prosthetic Knee-Shin Systems - Correct Coding Retired - Correct Coding - Custom Fabricated Wheelchair Seat and Back Cushions Custom Fabricated Wheelchair Seat and Back Cushions - Correct Coding - Revised COVERAGE AND CORRECT CODING OF DUOPA® (LEVODOPA-CARBIDOPA ENTERAL SUSPENSION) JOINT DME MAC PUBLICATION – REVISED Retired - Manual Wheelchair Bases Retired - Manual Wheelchair Bases Manual Wheelchair Bases - Correct Coding - Revised Retired - Coverage and Coding – New Oral Antiemetic Drug Akynzeo®Retired - Coverage and Coding – New Oral Antiemetic Drug Akynzeo® – Revised Retired - Coverage and Correct Coding of HYQVIA (Immune Globulin Infusion (Human) 10%, with Recombinant Human Hyaluronidase) – Revised Retired - Coverage and Correct Coding of HYQVIA Coverage and Correct Coding of HYQVIA (Immune Globulin Infusion (Human) 10%, with Recombinant Human Hyaluronidase) – Revised Correct Coding – New Oral Antiemetic Drug Akynzeo® - Revised Retired - Code Verification Review Requirement for Articulating Digit(s) and Prosthetic Hands Code Verification Review Requirement for Articulating Digit(s) and Prosthetic Hands - Revised Retired - Heating Pads and Heat Lamps – Draft Medical Policy Finalized