Surgical Dressings Billing Update

A review of claims for surgical dressings by NHIC, Corp. identified billing discrepancies regarding the correct use of modifiers A1 – A9. The use of these modifiers is required, but the way in which durable medical equipment (DME) suppliers are using them is questionable, according to the DME Medicare Administrative Contractor (MAC) for Jurisdiction A.

According to NHIC, suppliers must always use the appropriate modifier (A1-A9) based on the number of wounds being treated. For example, when billing for A6216 Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing, modifier A1 Dressing for one wound should be used if one wound is being treated. For two wounds, modifier A2 Dressing for two wounds should be appended to the HCPCS Level II code, and so on.

Suppliers can review the documentation requirements and utilization parameters as outlined in the Local Coverage Determination (LCD) and policy article on NHIC’s DME website.

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