Advisory Articles




Advisory Articles Articles


Billing of Powered L-Coded Items - Correct Coding - RevisedL1690 Prefabricated Bilateral Lumbo-sacral Hip Orthosis - Correct CodingL1005 - Tension Based Scoliosis Orthosis and Accessory Pads, Includes Fitting and Adjustment - Correct CodingRetired - Correct Coding - MyoPro (Myomo, Inc.) Assist Device - RevisedParenteral Nutrition - Correct Coding and BillingRetired - Correct Coding - Powered Exoskeleton ProductsEnteral Nutrition - Correct Coding and BillingL1686 Prefabricated Hip Abduction Orthosis - Correct CodingRetired - Correct Coding and Coverage of Ventilators – Revised April 2019Scoliosis Brace - Correct CodingRetired - Correct Coding and Coverage - Panzyga® (Immunoglobulin Intravenous (Human), 10%)Correct Coding - U 500 Insulin for Use in External Insulin Infusion PumpsHCPCS CODE UPDATE – 2011Correct Coding – 2019 HCPCS Code Annual Update - CorrectedHCPCS Code Update- 2009Correct Coding for Items Used to Treat Edema - RevisedProsthetic Feet and Additions to Lower Limb Extremity Prostheses - Correct Coding and Coding Verification Review RequirementContinuous Glucose Monitor Supplies - Correct Coding and BillingKF Modifier Use - Correct CodingPanzyga® (Immunoglobulin Intravenous (Human), 10%) Correct Coding and Coverage - Revised2020 HCPCS Code Annual Update - Correct Coding - RevisedIncorrect Use of HCPCS Code A9279 - Correct CodingCorrect Coding - Articulating Digit(s) and Prosthetic Hands - RevisedPartial Hand Prostheses - Correct CodingNew HCPCS Code - Revefenacin (Yupelri®) - J7677Endoskeletal Prosthetic Knee-Shin Systems - Correct CodingENTERAL NUTRITION SUPPLY KITS - B4034-B4036ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER – CODING VERIFICATION REVIEW REQUIREMENTHCPCS CODE A9283 – DEVICES USED FOR EDEMA OR ULCER HEALINGORAL ANTI-CANCER DRUGS – CODING AND BILLING CHANGETRANSCUTANEOUS ELECTRICAL NERVE STIMULATORS (TENS) SOLD OVER-THE-COUNTER – CODING GUIDELINESMANUAL WHEELCHAIR BASESCODING GUIDELINES FOR THERAPEUTIC SHOES FOR PERSONS WITH DIABETESHCPCS CODE UPDATE – (2014)Retired - Correct Coding for Pneumatic Compression DevicesMULTIPLE COPIES OF APPLICATIONS NOT NEEDEDCORRECT CODING AND BILLING OF CANTILEVER TYPE ARMRESTCLARIFICATION OF BILLING SURGICAL DRESSINGS AS COMPONENTS OF KITSCORRECT CODING – SAFETY EQUIPMENT PACKAGES WITH POWER OPERATED VEHICLES (POVS)HCPCS CODE E0571 - INVALIDRetired - Ankle-Foot Orthoses – Arizona-Type – Correct CodingFUNCTIONAL ELECTRICAL STIMULATORS – NEW CODEPDAC CONTRACT EFFECTIVE AUGUST 18, 2008HCPCS CODE UPDATE - (2010) - REVISEDTRACHEOSTOMY CARE KIT - CODING GUIDELINESBILLING FOR CAPECITABINE (XELODA®) 500 MG DOSAGE FORM – EUROPEAN FORMULATION BLISTER PACKPower Mobility Device Independent Testing RequirementsREVISED – POWER MOBILITY DEVICE INDEPENDENT TESTING REQUIREMENTSHCPCS CODE UPDATE – 2012HCPCS CODE UPDATE – 2013REMINDER - ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER – CODING VERIFICATION REVIEW REQUIREMENTCORRECT CODING – SURGICAL DRESSINGS CONTAINING MEDICAL HONEYCORRECT CODING – SUPPLIES USED WITH E0446 – JOINT DME MAC PUBLICATIONSPEECH GENERATING DEVICE – INFORMATION REQUIRED FOR CODING VERIFICATION REVIEWREVISED – POWER MOBILITY DEVICE INDEPENDENT TESTING REQUIREMENTS EFFECTIVE OCTOBER 1, 2015RETIRED – CORRECT CODING – CEFALY®SPEECH GENERATING DEVICES – CODING VERIFICATION REVIEW REQUIREMENT – UPDATERetired - Correct Coding - Lithium Batteries - UpdatedBREATHE NIOV™ - CODING REMINDER – REVISED JANUARY 2014COVERAGE AND CORRECT CODING OF HYQVIA (IMMUNE GLOBULIN INFUSION (HUMAN) 10%, WITH RECOMBINANT HUMAN HYALURONIDASE) – REVISEDNEW OFF-THE-SHELF ORTHOTIC CODESCOVERAGE AND CODING – NEW ORAL ANTIEMETIC DRUG AKYNZEO®Retired - Coverage and Correct Coding of Continuous Glucose Monitoring (CGM) Devices - RevisedCOVERAGE AND CORRECT CODING OF HYQVIA®CORRECT CODING – DRUGS AND FLUIDS CORRECT CODING – DIATHERMY AND BIOFEEDBACK DEVICESMANUAL WHEELCHAIR BASESRetired - Coverage and Correct Coding of Continuous Glucose Monitoring DevicesCORRECT CODING – SURGICAL DRESSINGS CONTAINING NON-COVERED COMPONENTSCORRECT CODING – ORAL ANTICANCER DRUGS AND PDAC’S NDC/HCPCS CROSSWALK LISTINGSCORRECT CODING – 2016 HCPCS CODE ANNUAL UPDATECOVERAGE REMINDER – SPEECH GENERATING DEVICES Retired - Correct Coding - Negative Pressure Wound Therapy (NPWT)CORRECT CODING – IDEO AND EXOSYM ENERGY STORING AFORetired - Continuous Glucose Monitors - Frequently Asked QuestionsRetired - Correct Coding – NOC Codes for Enteral (B9998) and Parenteral (B9999) NutritionCORRECT CODING – HYGIENIC CLEANSERS, DIAPERS, AND UNDER-PADSCOVERAGE AND CORRECT CODING OF CUVITRU™Retired - Coding and Coverage - Therapeutic Continuous Glucose Monitors (CGM)Retired - Speech Generating Devices – Coding Verification Review RequirementCORRECT CODING – HCPCS CODING RECOMMENDATIONS FROM NON-MEDICARE SOURCESCORRECT CODING OF CUVITRU™ REVISEDRetired - Correct Coding - inFlow™ Intraurethral Valve-Pump (Vesiflo, Inc.)CORRECT CODING – DIAPERS AND UNDERPADSRetired - Correct Coding - Manual Wheelchairs Constructed of TitaniumRetired - Correct Coding and Coverage of Ventilators – Revised May 2016CORRECT CODING – 2017 HCPCS CODE ANNUAL UPDATERetired - Correct Coding - 2019 HCPCS Code Annual UpdateCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Battery ChargerCorrect Coding - Warranty, Reasonable Useful Lifetime (RUL), and the Minimum Lifetime Requirement (MLR) for Durable Medical EquipmentCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Wheelchair TrayCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for an ActuatorRetired - Correct Coding - Q9994 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH) Coverage Indicator ChangedCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Anti-Tip Devices for Manual WheelchairsRetired - Correct Coding - Inserts Used with Therapeutic Shoes for Persons with Diabetes (A5512, A5513, K0903)Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Wheel Lock Brake Extension for Manual WheelchairsCorrect Coding – Incorrect Use of HCPCS Code K0108 To Bill for a Wheelchair HeadrestCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Labor ChargesCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Transit System and Associated BracketCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Front Riggings: Shoe Holder or Shoe Holder Replacement StrapsContinuous Glucose Monitors - Use of Smart DevicesTopical Oxygen Therapy Used For Wound Care - An UpdateCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Battery ReplacementCorrect Coding - Custom Fabricated Wheelchair Seat and Back CushionsCorrect Coding – Replacement Cecostomy TubeCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Replacement of Wheelchair Seat and Back UpholsteryCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Front Riggings: Calf Pad or Calf SupportCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Privacy FlapCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for Wheelchair Ventilator TrayCorrect Coding - A9286 - Hygienic Item or Device, Disposable or Non-disposable, Any Type, EachRetired - 2020 HCPCS Code Annual Update - Correct CodingPDAC Coding Guidelines for Off-the-Shelf Diabetic Shoes (A5500)CORRECT CODING – INSULIN USED WITH CONTINUOUS EXTERNAL INSULIN INFUSION PUMPSRetired - Correct Coding and Coverage of Ventilators - Revised January 2019HCPCS CODE L0430 - INVALIDRetired - Correct Coding – “No-Touch” CathetersREVISED – COLLAGEN SURGICAL DRESSINGS – CODING VERIFICATION REVIEW REQUIREMENTK0009 MANUAL WHEELCHAIR – CODING VERIFICATION REVIEW REQUIREMENTRetired - Correct Coding Reminder - Duopa® (AbbVie)CORRECT CODING – WEIGHTLESS WALKERCOVERAGE AND CORRECT CODING OF YONDELIS®Retired - Correct Coding – Center Mounted Elevating Leg RestCORRECTION – NEW MODIFIER CS – EFFECTIVE DATE APRIL 20, 2010CORRECT CODING – INTEGRATED RESPIRATORY PRODUCTSCORRECT CODING – BUZZY®Retired - Correct Coding - Not Otherwise Classified (NOC) HCPCS Codes Used for DrugsRetired - Correct Coding and Coverage of VentilatorsRetired - Correct Coding and Coverage – Peristeen® Transanal Irrigation (PAI) SystemWALKER UNBUNDLING BILLING FOR BRAKESCORRECT CODING – VIBRATION THERAPY DEVICESCORRECT CODING – NEW ORAL ANTIEMETIC DRUG AKYNZEO® - JOINT DME MAC PUBLICATION REVISEDCORRECT CODING INSTRUCTIONS – A4358 URINARY COLLECTION BAGCORRECT CODING – BEMER PHYSICAL VASCULAR THERAPY DEVICESMANUAL WHEELCHAIR BASES - CORRECT CODING - REVISEDPOLICY ARTICLE REVISION – VACUUM ERECTION DEVICES (VED)CORRECT CODING – FITNESS MONITORING TECHNOLOGIESRetired - MyoPro™ - Coding ReminderCORRECT CODING OF CONTINUOUS PASSIVE MOTION DEVICESCOVERAGE AND CORRECT CODING OF DUOPA® (LEVODOPA-CARBIDOPA ENTERAL SUSPENSION) JOINT DME MAC PUBLICATION – REVISEDCORRECT CODING - A5513 CUSTOM MOLDING REQUIREMENTSE0486 – CUSTOM FABRICATED ORAL APPLIANCE FOR OSA – CODING AND UTILIZATION GUIDELINESHCPCS CODE UPDATE – (2015)Retired - Correct Coding - Center Mount Elevating Leg Rest - RevisedCorrect Coding - Lithium Batteries - RevisedCorrect Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Drive Wheel Gear BoxCOVERAGE AND CODING – NEW ORAL ANTIEMETIC DRUG AKYNZEO – REVISEDCORRECT CODING AND COVERAGE – E0740 NON-IMPLANTABLE PELVIC FLOOR ELECTRICAL STIMULATORL3960 - Coding Verification Review RequirementCORRECT CODING – LINERS USED WITH POSITIVE AIRWAY PRESSURE (PAP) MASKCOVERAGE AND CORRECT CODING OF DUOPA® (LEVODOPA-CARBIDOPA ENTERAL SUSPENSION)CORRECT CODING REMINDER - MONITORING TECHNOLOGY USED WITH POSITIVE AIRWAY PRESSURE DEVICES (PAP) AND RESPIRATORY ASSIST DEVICES (RAD)Retired - Coverage and Correct Coding of Blincyto™ – RevisedUROLOGICAL SUPPLIES – A4353 CORRECT CODING CLARIFICATION POLICY REVISIONCORRECT CODING – TOBI® PODHALER™Retired - Correct Coding and Coverage - RELiZORB (Alcresta Therapeutics) In-Line CartridgeCORRECT CODING – ARGUS® II RETINAL PROSTHESIS SYSTEMRETIRED - CORRECT CODING – PRO-FLEX® PROSTHETIC FOOT (ÖSSUR)K0009 MANUAL WHEELCHAIR – CODING VERIFICATION REVIEW REQUIREMENT – UPDATECORRECT CODING – L0174 CODING REVIEWCORRECT CODING – CAST COVERSCORRECT CODING – ORAL APPLIANCES NOT USED FOR THE TREATMENT OF OBSTRUCTIVE SLEEP APNEACORRECT CODING AND COVERAGE – ORAL SUSPENSIONS USED IN THE TREATMENT OF ORAL MUCOSAL INJURIESCORRECT CODING – INTERFERENTIAL CURRENT (IFC) THERAPY DEVICESRetired - Correct Coding - Lithium BatteriesCORRECT CODING – 2018 HCPCS CODE ANNUAL UPDATEK0009 MANUAL WHEELCHAIR – CODING VERIFICATION REVIEW REQUIREMENT – DEADLINE EXTENDEDRESPIRATORY ASSIST DEVICES – E0472Retired - Correct Coding – Pneumatic Compression Devices and Related Appliances – RevisedRetired - Correct Coding - Otto Bock C-Leg Coding - RevisedRetired - Correct Coding – Billing of Powered L-Coded ItemsRetired - Glucose Monitors LCD and Related Policy Article - RevisedCORRECT CODING – FULL LENGTH ROCKER SOLES ADDED TO THERAPEUTIC SHOESCORRECT CODING – TRACHEOSTOMY TUBESCANTILEVER TYPE ARMREST – CORRECT CODINGCODING GUIDELINE – K0900 (CUSTOM DURABLE MEDICAL EQUIPMENT, OTHER THAN WHEELCHAIRS)CORRECT CODING FOR ORAL APPLIANCES FOR THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA (E0486)CORRECT CODING – P-STIM® DEVICERetired - Correct Coding and Coverage of Ventilators – Revised Effective January 1, 2016COLLAGEN SURGICAL DRESSINGS – CODING VERIFICATION REVIEW REQUIREMENTREVISED – K0009 MANUAL WHEELCHAIR – CODING VERIFICATION REVIEW REQUIREMENTCONCENTRIC ADJUSTABLE TORSION JOINTS – CORRECT CODINGWHAT IS THE DIFFERENCE BETWEEN THE PDAC AND THE DME MACS?Retired - Correct Coding - Articulating Digit(s) and Prosthetic HandsCORRECT CODING – SPEEDICATH® FLEX COUDÉ CATHETER (COLOPLAST)EXERCISE EQUIPMENT - CORRECT CODINGREQUIREMENTS FOR CODING REVIEW OF CUSTOM FABRICATED SPINAL ORTHOSESCorrect Coding - Porta-Lung Negative Pressure Ventilator - RevisedCORRECT CODING INSTRUCTIONS – PORTA-LUNG® NEGATIVE PRESSURE VENTILATORHEATING PADS AND HEAT LAMPS – DRAFT MEDICAL POLICY FINALIZEDCORRECT CODING - APNICURE WINX® SLEEP THERAPY SYSTEMCORRECT CODING – HCPCS CODING OF SURGICAL DRESSINGS – COMPONENTS TO REPORT ON THE PDAC HCPCS CODE VERIFICATION APPLICATIONHEIGHT STANDARDS FOR CODING LSO AND TLSO - REVISEDCORRECT CODING – URINARY DRAINAGE TUBE ADAPTERCORRECT CODING – A5513 PRODUCT CODING REDETERMINATION PROJECTCORRECT CODING – HYGIENIC ITEMS, WASH CLOTHS, AND CLEANSING WIPESRetired - Spinal Orthosis – Coding Verification Review RequirementRetired - Charcot Restraint Orthotic Walker - Crow Boot - CodingRetired - Charcot Restraint Orthotic Walker – Crow Boot – Coding UpdateRetired - Coding Instructions - Microprocessor Controlled Knee ProsthesesRetired - Elastic Garments – NoncoveredRetired - Correct Coding – LIM Innovations Infinite Socket™Retired - Pneumatic Knee Splint – Coding Verification Review RequirementRetired - LIM Innovation Infinite Socket - Correct Coding - RevisedRetired - Correct Coding – LIM Innovation Below Knee SocketRetired - Correct Coding – LIM Innovations Infinite Socket™ – RevisedRetired - Coding Guidelines for Ankle Foot OrthosesRetired - Revised - Coding Guidelines for Ankle-Foot OrthosesRetired - Submitting Diabetic Shoe Inserts for CodingRetired - Correct Coding Instructions – Endolite Echelon® Prosthetic FootCorrect use of Not Otherwise Specified L-codes for Orthoses and Prostheses - Billing ReminderRetired - Correct Coding - MyoPro® (Myomo, Inc.) Assist DeviceMyoPro® (Myomo, Inc.) Assist Device - Correct Coding - RevisedRetired - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - RevisedRetired - Correct Coding – Definitions Used for Off–the–Shelf Versus Custom Fitted Prefabricated Orthotics (Braces) – RevisedRetired - Correct Coding and Billing for Microprocessor-Controlled Knee SystemsRetired - Correct Coding – Braces (Orthoses) Attached to WheelchairsRetired - Appropriate Coding and Billing of Lower Limb Prosthetic Covers and Covering SystemsRetired - Correct Coding - Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - RevisedInsulin Infusion Pumps with Integrated Continuous Glucose Sensing Capabilities and Related Accessories/Supplies – Codes E0787 and A4226 - Correct CodingCorrect Coding and Coverage of Ventilators - Revised July 2020Custom Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code - Correct CodingRetired - MyoPro® (Myomo, Inc.) Assist Device - Correct Coding - RevisedRetired - Incorrect Use of HCPCS Codes for Custom Fit OrthoticsRetired - Vacuum Erection Device – Coding Verification Review RequirementAnkle-Foot Orthoses - Arizona-Type - Correct Coding - RevisedRetired - Correct Coding – Whill Model A Powered Personal Mobility DeviceRetired - Correct Coding – Billing of HCPCS Code E0986Retired - Correct Coding – Bariatric Pressure Reducing Support SurfacesRetired - Correct Coding – Whill Powered Personal Mobility Devices – RevisedDefinitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) - Correct Coding - RevisedRetired - Correct Coding – Ankle Orthoses, With or Without Joints, Prefabricated or Custom Fabricated Coding Verification ReviewRetired – Correct Coding – Martin Bionics Socket-Less Socket – RevisedRetired - Hand-Finger Orthoses – Use of CG Modifier – RevisedRetired - Hand Finger Orthoses (L3923) - Use of CG ModifierCorrect Coding and Coverage – Braces Constructed Primarily of Elastic or Other Fabric Materials – RevisedRetired - Correct Coding and Coverage – Braces Constructed Primarily of Elastic or Other Fabric MaterialsRetired - Correct Coding – Submitting Diabetic Shoe Inserts for HCPCS Coding – PDAC Coding Application InstructionRetired - Ankle-Foot Orthoses – Arizona-Type – Correct Coding – RevisedRetired - Xembify® - Correct CodingRetired - Coverage and Correct Coding of Blincyto™COVERAGE AND CORRECT CODING OF HYQVIA (IMMUNE GLOBULIN INFUSION (HUMAN) 10%, WITH RECOMBINANT HUMAN HYALURONIDASE) – REVISED JOINT DME MAC PUBLICATION – REVISEDRetired - Correct Coding – Eclipse™ Vaginal Insert System (Pelvalon, Inc.)Correct Coding - PROSE ® DeviceRetired - Coverage and Coding – New Oral Antiemetic Drug Varubi™Retired – Correct Coding – Eclipse™ Vaginal Insert System (Pelvalon, Inc) - RevisedRetired - Coverage and Coding – New Oral Antiemetic Drug Varubi® – Revised – Effective Date July 1, 2016