DMEPOS July 2009 Update Calls for Action

Failure to heed an update to the Durable Medical Equipment, Prosthetics, Orthotics and Suppliers (DMEPOS) Fee Schedule could mean lost revenue for your practice.

The July 2009 Quarterly Update to the DMEPOS Fee Schedule revises the 2009 allowed payment amount for HCPCS Level II codes E1340/K0739 Repair or nonroutine service for durable medical equipment requiring the skill of a technician, labor component, per 15 minutes. The new allowed payment amount for these codes is listed in the attachment to the Centers for Medicare & Medicaid Services (CMS) transmittal 1754, change request 6511, issued June 5.

Contractors will not automatically adjust the difference in payment amounts. Providers should resubmit claims for E1340 with dates of service between Jan. 1 and March 31 and claims for K0739 with dates of service between April 1 and Dec. 31.

CMS is also adding modifier AW Item furnished in conjunction with a surgical dressing to the DMEPOS fee schedule for HCPCS Level II code A6545 Gradient compression wrap, non-elastic, below knee, 30-50 mm HG, each. Code A6545 is covered when used in treatment of an open venous stasis ulcer.

A 2008 post on Noridian’s Web site offers this guidance for A6545:

“When a gradient compression wrap, A6545, is used for an open venous stasis ulcer, the code must be billed with the AW modifier. If there is no open ulcer, the AW modifier must not be used. Claims for code A6545 without an AW modifier will be denied as statutorily noncovered.

“The right (RT) and left (LT) modifiers must also be used with this code. When the same code for bilateral items (left and right) is billed on the same date of service, bill both items on the same claim line using LTRT modifiers and 2 units of service.

“The only products that may be billed with code A6545 (non-elastic compression wrap) are those which have received a written Coding Verification Review from the Pricing, Data Analysis, and Coding (PDAC) contractor and that are posted in the Product Classification List on the PDAC web site.”

The fee schedule amount for this code is established as part of this update and is effective for claims with dates of service on or after Jan. 1, 2009. This item was paid on a local fee schedule basis prior to implementation of the fee schedule amount established with this update. You cannot, however, resubmit claims for code A6545 with service dates on or after Jan. 1 for an adjustment.

Lastly, realizing that there are currently no devices categorized and billed under HCPCS Level II code K0606 External defibrillator, with integrated electrocardiogram analysis, garment type without modifier KF Item designated by FDA as class III device, the fee schedule amounts for K0606 billed without the KF modifier are being removed from the DMEPOS fee schedule file as part of this update.

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