DME MACs to Stop Covering Voice Prostheses Claims

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  • April 30, 2010
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Providers will soon need to submit claims for tracheo-esophageal voice prostheses somewhere other than to their Durable Medical Equipment Medicare Administrative Contractor (DME MAC).
The Centers for Medicare & Medicaid Services (CMS) is changing the claims filing jurisdiction for HCPCS Level II code L8509 Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type. Effective Oct. 1, 2010, such claims should be billed to the applicable Part A/B MAC or Part B carrier.

Tracheo-esophageal voice prostheses that are changed by the patient/caregiver in the home setting (rather than in a physician’s office or other outpatient setting) are billed using HCPCS code L8507 Trachea-esophageal voice prosthesis, patient inserted, any type, each and are eligible for coverage under the prosthetic device benefit. The filing jurisdiction for these claims remains with the DME MACs.
Note: Medicare will not cover the prosthesis if it is shipped or dispensed to the patient, who then takes the item to a physician’s office for insertion.
Source: CMS Transmittal 686, Change Request (CR) 6743, issued April 29

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