Code Search Use the code search to determine the appropriate code to submit on your claim: Enter one procedure code or view a list of all procedure codes included on the device-intensive procedure list.
Full Answer
How do I verify the HCPCS code for my product?
Code verification is handled by the PDAC, a Medicare contractor (Palmetto GBA holds the contract). The PDAC can be accessed through dmepdac.com, which lists all of the products that have been code verified. The PDAC can only verify that a product meets the definition of an existing HCPCS code.
What is the Medicare billing code for equipment?
In order for Medicare to cover and pay for equipment, the product must fit within an established Medicare billing code, known as a HCPCS code, or it may be billed using the miscellaneous DME HCPCS code (E1399).
How do I request help with billing place of service codes?
NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. Please sign and date each request. Be certain to provide the name, mailing address, telephone number, fax number, and e-mail address of the person to be contacted regarding this request.
How do I sign up for Medicare?
Contact Social Security to sign up for Medicare. Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
What is a device code in medical billing?
The code is a standard alphanumeric sequence that describes drugs, medical devices, and medical and surgical procedures and services. Coding is intrinsically linked with coverage and payment. Healthcare providers use these codes to bill payers for services (and associated costs) rendered to patients.
How do I get HCPCS code?
Application for a New HCPCS Code The application and its process are on CMS's website at: cms.gov/medicare/coding/medhcpcsgeninfo. The application process for DMEPOS items occurs twice a year. Applications are generally due around January 1 and July 1 every year.
Where do I find Medicare CPT codes?
To find the CPT or HCPCS billing code, look on the bill provided to you by your health care provider. You may also download a zip file of the 2022 HCPCS codes, then select the “January 2022 Alpha-Numeric HCPCS File (ZIP).”
What are the requirements for coding durable medical equipment?
The Special Process of DME Billing and Coding. Durable medical equipment must be prescribed by a medical doctor, found medically necessary, and then approved by the patient's insurance company. Only then can the equipment be distributed to the patient.
What is the difference between a HCPCS and CPT code?
1. CPT is a code set to describe medical, surgical ,and diagnostic services; HCPCS are codes based on the CPT to provide standardized coding when healthcare is delivered.
Are HCPCS codes only for Medicare?
Coders today use HCPCS codes to represent medical procedures to Medicare, Medicaid, and several other third-party payers. The code set is divided into three levels. Level one is identical to CPT, though technically those codes, when used to bill Medicare or Medicaid, are HCPCS codes.
What does a CPT code look like?
A CPT code is a five-digit numeric code. It has no decimal marks. Some have four numbers and one letter. Codes are assigned to different actions.
Is a CPT code a procedure code?
CPT codes®, or the Current Procedural Terminology codes, are five-digit procedure codes that describe the service rendered by the healthcare professional. The MNT codes 97802, 97803, and 97804 are CPT® codes that RDNs use on claims to report nutrition services provided by the RDN.
What is a CPT code example?
CPT (Current Procedural Terminology) codes are a worldwide coding system for medical treatments. Each operation is assigned a five-digit code that indicates the type of service supplied to health insurance companies. The code 90387, for example, is described as “Individual Psychotherapy. 60 minutes.”
Does durable medical equipment have CPT codes?
There are over 500 Healthcare Common Procedure Coding System (HCPCS) codes for Durable Medical Equipment (DME) for patients' every day and extended use. This equipment includes oxygen systems and accessories, canes, wheelchairs, crutches, infusion pumps and glucose monitors.
What is the ICD 10 code for durable medical equipment?
Claims for DME for a disabled parent must be submitted using HCPCS code A9999 (miscellaneous DME supply or accessory, not otherwise specified), ICD-10-CM diagnosis code Z73. 6 and modifier SC.
What is a Medicare DME claim?
covers. medically necessary. Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. DME if your doctor prescribes it for use in your home.
WHO publishes HCPCS?
HCPCS (HCPCS - Healthcare Common Procedure Coding System) - Synopsis. The Healthcare Common Procedure Coding System (HCPCS) is produced by the Centers for Medicare and Medicaid Services (CMS).
Are HCPCS codes in the CPT book?
What is HCPCS? The Healthcare Common Procedure Coding System (HCPCS) consists of two levels: HCPCS Level I codes – These are the CPT codes which consists of codes and descriptive terms that are used to report medical services and procedures furnished by physicians, other providers, and healthcare facilities.
How often are HCPCS codes published?
quarterlyThe complete HCPCS file is updated and released quarterly to the Medicare contractors. The file contains existing, new, revised and discontinued HCPCS codes for the October 2021 quarter. Contractors must download the file via the CMS mainframe in September 2021.
How many HCPCS codes are there in 2020?
PUBLICATION OF CMS HCPCS LEVEL II CODE DECISIONS FOR TEN 510(K)-CLEARED WOUND CARE PRODUCTS PROCESSED DURING CMS' 2020 AND 2021 HCPCS CODE APPLICATION REVIEW CYCLES.
How to buy equipment for Medicare Part B?
Here are the steps you need to take to purchase equipment: Go to an in-person doctor visit, where your doctor will write an order for the DME. Take the order to a Medicare-approved DME supplier.
What is DME covered by Medicare?
Eligible DME costs are covered under Medicare Part B from an approved provider who accepts assignment. Regardless of whether you rent or buy equipment, Medicare pays 80 percent of costs after you meet your deductible. You then pay 20 percent coinsurance and your monthly premium costs.
What is a Medigap plan?
Medigap. Medigap is supplemental insurance you can buy to help pay coinsurance and copayment costs not covered by original Medicare. Since Medicare Part B pays 80 percent of covered DME costs, a Medigap plan may be a good option to help pay some, or all, of the balance of your DME products.
How long does Medicare pay for oxygen?
Medicare pays 80 percent of the rental fees for the oxygen and any supplies for 36 months. You must still pay the 20 percent coinsurance each month.
What does Medicare Part A cover?
Part A. Medicare Part A covers hospital stays, hospice care, and limited home health and skilled nursing facility care. If DME supplies are required during your stay at any of these facilities, Medicare expects the provider to pay for these costs based on your Part A benefits.
What is DME in Medicare?
Millions of Medicare beneficiaries rely on durable medical equipment (DME) every day. This includes canes, nebulizers, blood sugar monitors, and other medically necessary supplies to improve quality of life and maintain independence at home.
How long does Medicare pay for rental equipment?
A Medicare-approved supplier will know if you can buy an item. Original Medicare pays 80 percent of the monthly costs for 13 months of rental. If you still need the equipment after this time, depending on the type of product, you may be allowed to own it.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L35490 Category III Codes with the exception of the following CPT codes:
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What is assignment in Medicare?
Assignment —An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
Does Medicare pay for DME repairs?
Medicare will pay 80% of the Medicare-approved amount (up to the cost of replacing the item) for repairs. You pay the other 20%. Your costs may be higher if the supplier doesn’t accept assignment.
Why is HCPCS code verification not mandatory?
When code verification is not mandatory, the manufacturer may nevertheless seek it in order to get certainty regarding the correct HCPCS code to be used when billing Medicare. The manufacturer can then inform customers of the correct HCPCS code that can be used to bill for the product, and that code will drive the coverage and payment rules for ...
Who handles code verification?
Code verification is handled by the PDAC, a Medicare contractor (Palmetto GBA holds the contract). The PDAC can be accessed through dmepdac.com, which lists all of the products that have been code verified. The PDAC can only verify that a product meets the definition of an existing HCPCS code. The PDAC does not have the authority to create a HCPCS code or amend an existing HCPCS code description. Code verification is mandatory for some products, but not for others. The PDAC maintains a list of which DMEPOS items are subject to mandatory code verification.
What happens if miscellaneous code is used?
If the miscellaneous code option is used, the Medicare Administrative Contractors that process the claims will individually review the claim and determine whether Medicare will cover and pay for the item; this can be a time consuming and predictable process. If there is no existing HCPCS code that describes the product, ...
How long does it take to get a PDAC code?
Code verification takes about 65 days. The application form and accompanying instructions are on the PDAC website. As a matter of practice, all payers generally follow the PDAC’s code verification decisions, not just Medicare.
When are DMEPOS applications due?
The application process for DMEPOS items occurs twice a year. Applications are generally due around January 1 and July 1 every year. Once CMS makes a preliminary decision, it holds a public meeting in which applicants can present more information. CMS then makes a final decision to either grant a new HCPCS code or not.
Can a PDAC verify a product?
The PDAC can only verify that a product meets the definition of an existing HCPCS code. The PDAC does not have the authority to create a HCPCS code or amend an existing HCPCS code description. Code verification is mandatory for some products, but not for others.
What is IDE in Medicare?
Instructions: Medicare Coverage Related to Investigational Device Exemption (IDE) Studies. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) allowed Medicare payment of the routine costs of care furnished to Medicare beneficiaries in certain categories of Investigational Device Exemption (IDE) studies.
How long does it take CMS to review a study?
CMS will review each complete submission within approximately thirty days. Study sponsors that have been disapproved may submit revised protocols. Upon request, CMS can meet with study sponsors/applicants for coverage and provide feedback about favorable study protocol adjustments to help improve the likelihood of approval upon resubmission.
Is a request letter separate from an IDE?
Each document type should be a separate file ( i.e., the Request Letter should be separate from the IDE Study Protocol). Word, PDF, and Excel file types are preferred. Word-searchable PDF documents enable a more efficient review.
