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Portable Pump Billing to DMERC & Medicare?

SJCCPC

New
Messages
9
Location
Cape Coral, FL
Best answers
0
Hello,

We have been billing the E0781 (Pump) and (A4222) to DMERC for years. We own the supplies for the locations we bill DMERC. Medicare is billed the clinical portion, OV's and other drugs to Medicare. The pump admin code 96416 is also billed on the clinical claim to Medicare.

Is this allowed? I received the article from MLN yesterday and I questioning if I am billing correctly. Am I allowed to bill both DMERC and Medicare? I saw an article that read we cannot bill both supplies and the administration codes

Some of the common drugs given via pump is Yondelis, which we bill to Medicare (Unlisted code). DMERC is billed for Mesna, Ifex, and 5FU.

Any insight or advice would be much appreciated.

Thank you!

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1609.pdf
 

relong

Guru
Messages
134
Location
Bettendorf, Iowa
Best answers
0
There's been an uproar over this topic lately. Until now its depending on what your local wanted. We're struggling with our pump supplier to figure out whats going on and how this will be handled. Rumor is CMS is eliminating 96416 and creating a new bundle code mid-year to discourage the use of a new drug, not realizing the impact that decision makes on other regimens. I've only heard this from one source so I don't know how true this is. I wonder if anyone else has heard anything?
 
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