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❏❏❏The supplier should keep written proof ofmaintenance and servicing on fileMedicare allows maintenance and servicingcharges of one-half of one month’s rental everysix months after the rental period is exhaustedWhen billing, the supplier must use theappropriate modifiers; Medicare has devicemodifiers that indicate rental or purchase status;the modifiers follow the appropriate pumpHCPCS code (B9000 or B9002)➝ KH – used with initial month of pump rental➝➝KI – used during the 2 nd and 3 rd months of rentalKJ – used during the 4 th through 15 th monthsof rental➝➝BP – beneficiary elected to purchase thepump; used with first claim and on the 9 th ,10 th , 11 th or 12 th month of rentalBR – beneficiary refused purchase option➝ BU – beneficiary or his/her legalrepresentative was informed of option topurchase pump, but failed to respond; rentalpayments will continue through the 15 th monthEnteral FormulasMedicare classifies enteral nutrition formulas into sixcategories* based on on nutritional composition. Thefollowing Exhibit 8 is a list of the Medicare Part Bcoverage of Mead Johnson formulas:*Categorization may be subject to change. Any reimbursement should be confirmed with your Medicare DMERC.May, 2002 49
EXHIBIT 8 – MEDICARE APPROVED MEDICAL NUTRITION PRODUCTSPROVIDED BY MEAD JOHNSONHCPCS Category Description Mead Johnson Products Billable UnitsCode(per 8 oz can)B4150 Category I – ($0.61 per unit) Boost ® 2.4Semi-synthetic Intact Boost ® Breeze * 1.6Protein/Protein Isolates Boost ® with Fiber 2.4Boost ® High Protein 2.4Isocal ® 2.5Isocal ® HN 2.5Isocal ® HN Plus 2.8Kindercal ® 2.5Portagen ® 21.34**Ultracal ® 2.5Ultracal ® HN Plus 2.8B4152 Category II – ($0.51 per unit) Boost Plus ® 3.6Calorically Dense: Intact Comply ® 3.55Protein/Protein Isolates Deliver ® 2.0 4.7Respalor ® 3.55B4153 Category III – ($1.74 per unit) Criticare HN ® 2.5Hydrolyzed Protein/Amino Acid IntensiCal ® 5.1Subdue ® 2.4Subdue ® Plus 3.6B4154 Category IV – ($1.12 per unit) Choice DM ® TF 2.5Defined Formula for Special Choice DM ® Beverage 2.2Metabolic Needs Lipisorb ® 3.2Magnacal ® Renal 4.7Protain XL ® 2.37TraumaCal ® 3.55B4155 Category V – ($1.12 per unit) Casec ® 10.75**Modular Components Moducal ® 13.99**MCT Oil$72.52 per bottleMicrolipid ®4.0 per 3 ozNote: Comply ® ,Magnacal ® , Microlipid ® , and Protain XL ® are registered trademarks of Sherwood Services, AG. All othersare registered trademarks of Mead Johnson & Company.*Classification pending.**Per one can of powder.50
Page 2 and 3: Enteral ProductReimbursement Guidef
Page 4 and 5: PREFACEThe purpose of this manual i
Page 7 and 8: LIST OF EXHIBITSExhibit 1 - RUG III
Page 9 and 10: SECTION II - TYPES OF PAYERSThere a
Page 11 and 12: Concurrent ReviewConcurrent review
Page 13 and 14: SECTION III - MEDICARE BILLING FOR
Page 15 and 16: 12EXHIBIT 1 - RUG III URBAN RATES
Page 17 and 18: The following services are either i
Page 19 and 20: 16EXHIBIT 3 - SAMPLE MDS FORM (CONT
Page 41 and 42: 38EXHIBIT 4 - SAMPLE UB-92 FORM
Page 43 and 44: SECTION IV - SNF GUIDELINES FOR BIL
Page 45 and 46: SECTION V - ENTERAL BILLING FOR PAR
Page 47 and 48: ENTERAL PRODUCT COVERAGEEnteral pro
Page 49 and 50: 46EXHIBIT 6 - SAMPLE HCFA-1500 CLAI
Page 51: Enteral NutritionEnteral nutrition
Page 55 and 56: EXHIBIT 9 - ENTERAL THERAPY DIAGNOS
Page 57 and 58: MEDICARE DOCUMENTATIONSpecial docum
Page 59 and 60: 56EXHIBIT 10 - SAMPLE CMN (CONTINUE
Page 61 and 62: CMN GUIDELINESThe following are gui
Page 63 and 64: ❏❏❏➝Conversation notes betw
Page 65 and 66: EXHIBIT 13 - DIAGNOSES GENERALLY AC
Page 67 and 68: EXHIBIT 15 - EXAMPLE OF INDICATIONS
Page 73 and 74: EXHIBIT 16 - ENTERAL PRODUCTS REFER
Page 75 and 76: Method 2 - AWP + Service ChargeMore
Page 77 and 78: Once the number is obtained, the pr
Page 79: NOTES

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