DMEPOS Fee Update Includes Retroactive Changes

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
Month 36
Monthly Contents Payment after the Stationary Cap
Oxygen Concentrator (E1390, E1391, or E1392) None
Portable Gaseous or Liquid Transfilling Equipment (K0738 or E0433) None
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.

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