Wiki TENs unit and Medicare

[inc1961]

Good afternoon,

I am looking for guidance on billing a TENs unit to Medicare.
E0720. We used modifier NU (new) initially but that was rejected.
We used modifier KX (greater than 3 months pain) and the claim was denied for POS.
Medicare is stating this can only be billed by inpatient and outpatient hospitals?

Has anyone had recent success billing TENs units to Medicare. The patient takes home the unit.

Thank you

 

[thomas7331]

Which Medicare carrier are you billing this to - are you getting these denials from the DMERC or from your local MAC?

 

[inc1961]

We bill to both Novitas (NJ) and NGS (NY). However, these denials are for the local MAC., not DMERC The provider is not DME provider, which may likely be the cause. Novitas cannot give me a definitive answer.

Thank you

 

[thomas7331]

I think that's probably what is behind the denials. This is a DME that item isn't on the physician fee schedule so it won't be able to be paid by the Part B MAC - the provider would need to enroll with and bill to the DMERC.

 

[inc1961]

Thank you for your feed back. I told the provider this prior to billing, but I was hoping there was some other reason we were being denied.

Really appreciate your help!