By Kim Turner, RN, Clinical Consultant
Key points from the CMS CR 11570
New DMEPOS HCPCS codes have been added to the HCPCS file effective January 1, 2020. Suppliers can start using the new codes for billing effective on January 1, 2020. There are no deleted HCPCS codes from the DMEPOS fee schedule effective January 1, 2020.
New HCPCS Code Descriptions:
- A4226 - Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week
- B4187-PEN - Omegaven, 10 grams lipids
- E0787- External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing
- E2398 - Wheelchair accessory, dynamic positioning hardware for back
- K1001- Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
- K1002- Cranial electrotherapy stimulation (ces) system, includes all supplies and accessories, any type
- K1003- Whirlpool tub, walk-in, portable
- K1005- Disposable collection and storage bag for breast milk, any size, any type, each
- L2006- Knee ankle foot device, any material, single or double upright, swing and/or stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated
- L8033 PO- Nipple prosthesis, custom fabricated, reusable, any material, any type, each
- J0179- Injection, brolucizumab-dbll, 1 mg
- J9309- Injection, polatuzumab vedotin-piiq, 1 mg
DMEPOS Fees
Until national Medicare coverage and payment guidelines have been established for these new codes, there are no fees added to the DMEPOS fee schedule file for new HCPCS codes effective January 1, 2020. The Medicare coverage and payment determinations for these items are made based on the discretion of the DME MACs and A/B MACs Part B processing claims for these items. The DME MACs and A/B MACs Part B will establish local fee schedule amounts to pay claims for the new codes when applicable, and pay in accordance with the payment rules associated with each payment determination
For example, an item determined to be an expensive item of DME that is reasonable and necessary and not otherwise excluded from coverage by statute, regulations, an National Coverage Determination (NCD) or program instructions, must be paid on a capped rental basis in accordance with regulations at CFR 414.229. Fee schedule amounts for new HCPCS codes for items and services without a fee schedule pricing history are established using existing fee schedule amounts for comparable items when items with existing fee schedule amounts are determined to be comparable to the new items and services.
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