billing the dmercs and others for infusion pumps - ION Solutions

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COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791) External infusion pumps and related drugs and supplieswill be denied as not reasonable and necessary when thecriteria described by indication (I), (II), (III), (IV) or (V) arenot met. When an infusion pump is covered, the drug necessitatingthe use of the pump and necessary supplies are alsocovered. When a pump has been purchased by theMedicare program, other insurer, the patient, or the rentalcap has been reached, the drug necessitating the use of thepump and supplies are covered as long as the coveragecriteria for the pump are met. An external infusion pump and related drugs and supplieswill be denied as not reasonable and necessary in the homesetting for the treatment of thromb-oembolic disease and/orpulmonary embolism by heparin infusion. An infusion controller device (E1399) is not reasonable andnecessary.
COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791)An IV pole (E0776) is covered only when a stationary infusion pump (E0791) iscovered. It is considered not reasonable and necessary if it is billed with anambulatory infusion pump (E0779, E0780, E0781, E0784, or K0455).Supplies for the maintenance of a parenteral drug infusion catheter (A4221)are covered during the period of covered use of an infusion pump. They are alsocovered for the weeks in between covered infusion pump use, not to exceed 4weeks per episode.Supplies used with an external infusion pump, A4222 or K0552, are coveredduring the period of covered use of an infusion pump. Allowance is based on thenumber of cassettes or bags (A4222) prepared or syringes (K0552) used. Forintermittent infusions, no more than one cassette or bag is covered for eachdose of drug.For continuous infusion, the concentration of the drug and the size of thecassette, bag, or syringe should be maximized to result in the fewest cassettes,bags, or syringes in keeping with good pharmacologic and medical practice.Drugs and supplies that are dispensed but not used for completely unforeseencircumstances (e.g., emergency admission to hospital, drug toxicity, etc.) arecovered. Suppliers are expected to anticipate changing needs for drugs (e.g.,planned hospital admissions, drug level testing with possible dosage change,etc.) in their drug and supply preparation and delivery schedule.
Page 1: BILLING THE DMERCS ANDOTHERS FOR IN
Page 4 and 5: BUZZWORDSDIF-DME Information FormDM
Page 6 and 7: WHAT IS REIMBURSABLE DME? Payment m
Page 8 and 9: HOW IS DME CLASSIFIED? IN=Inexpensi
Page 10 and 11: PORTABLE PUMP: RENTAL PROVISIONS Ca
Page 12 and 13: OLD PUMP CMN—CMS FORM 851
Page 15 and 16: SNF CONSOLIDATED BILLING The Social
Page 17 and 18: MAIN DME CONTRACTORS Durable Medica
Page 19 and 20: DME MAC Types of Claims DME Prosthe
Page 21 and 22: NSC Contact Infohttp://www.palmetto
Page 23 and 24: CEDI Single front-end electronic so
Page 25 and 26: DME MAC COVERED DRUGS Epoetin alfa
Page 27 and 28: OTHER MODIFIERS JB: Administered su
Page 32 and 33: DIF DOCUMENTATIONSection 1833(e) of
Page 34 and 35: COVERAGE CONDITIONS FOR EXTERNALPUM
Page 42 and 43: HCPCS HCPCS Modifiers EY - No physi
Page 44 and 45: DMERC FEE SCHEDULECode Description
Page 46 and 47: 96416—INITIATION OF PROLONGEDINFU
Page 48 and 49: 96521-REFILLING AND MAINTENANCE OF
Page 50 and 51: A WORD ABOUT PRIVATE PAYERS(May Be
Page 52 and 53: OTHER THINGS ABOUT PRIVATE PAYERS W
Page 54 and 55: COMPLIANCE ISSUES Billing for items
Page 56 and 57: RESPONDING TO REQUESTS (CIGNA)Below
Page 58 and 59: CONCLUSIONS DME billing is complex,
Page 60: DME RESOURCES Durable Medical Equip

billing the dmercs and others for infusion pumps - ION Solutions

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