MIR-2006-7AB, July 2006

July Quarterly Update for 2006 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule

 
Note: This article was revised on June 2, 2006, to show that codes K0734-K0737 are added to the fee schedule file and are effective for claims submitted with dates of service on or after July 1, 2006, not January 1, 2006.

Provider Types Affected
Physicians, suppliers, and providers billing Medicare carriers, including durable medical equipment regional carriers (DMERCs) and/or fiscal intermediaries (FIs), including regional home health

intermediaries (RHHIs), for services paid under the DMEPOS Fee Schedule

Provider Action Needed

Background
The DMEPOS fee schedules are updated on a quarterly basis to:

• Implement fee schedule amounts for new codes; and
• Revise any fee schedule amounts for existing codes that were calculated in error.

Payment on a fee schedule basis is required for:

• Durable Medical Equipment (DME), prosthetic devices, orthotics, prosthetics and surgical dressings by the Social Security Act (Sections 1834(a)(h)(i)); and
• Parenteral and Enteral Nutrition (PEN) by regulations contained in the Code of Federal Regulations (42 CFR 414.102).

Changes Made in the Update
Changes made in this update include the following:

The fee schedule amounts for the following HCPCS codes are added to the fee schedule file as part of this update and are effective for claims with dates of service on or after January 1, 2006: 

The fee schedule amounts for HCPCS code K0733, Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorded glass mat) are added to the fee schedule file on July 1, 2006, and are effective for claims with dates of service on or after July 1, 2006.

The fee schedule amounts for HCPCS code E0762, Transcutaneous electrical joint stimulation device system, includes all accessories, are added to the fee schedule file on July 1, 2006, and are effective for claims submitted with dates of service on or after January 1, 2006. In addition, the payment category for code E0762 is being revised to move the joint stimulation device from the DME payment category for capped rental items to the DME payment category for inexpensive and routinely purchased items, effective July 1, 2006.

The fee schedule amounts for HCPCS codes L6694 and L6698 are added to the fee schedule file on July 1, 2006, and are effective for claims with dates of service on or after January 1, 2005.

The fee schedules for HCPCS code L2232, Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only, are added to the fee schedule file on July 1, 2006, and are effective for claims with dates of service on or after January 1, 2005.

Code E0705 (Transfer Board or Device, Any Type, Each) was added to the HCPCS effective January 1, 2006. The payment category for E0705 is being revised to the inexpensive and routinely purchased payment category and the fee schedule amounts for previous HCPCS code E0972 will be crosswalked to code E0705 for use in paying claims with dates of service on or after January 1, 2006.

The fee schedules for HCPCS code K0606 (Automatic External Defibrillator, With Integrated Electrocardiogram Analysis, Garment Type) are added to the fee schedule file on July 1, 2006, and are effective for claims submitted with dates of service on or after January 1, 2006.

The fee schedule amounts for HCPCS code E1812 (Dynamic Knee, Extension/Flexion Device with Active Resistance Control) are added to the fee schedule file on July 1, 2006, and are effective for claims submitted with dates of service on or after January 1, 2006.

As part of this update, the common working file category for HCPCS code B4185 will be switched from CWF category 9 to CWF category 20, effective January 1, 2006. B4185 was added to the HCPCS on January 1, 2006, to replace codes B4184 and B4186 and describes parenteral nutrients (CWF category 20) as opposed to enteral nutrients (CSF category 9).

Per CR4267, the following four adjustable wheel­chair cushions codes are added to the HCPCS, effective July 1, 2006:

• K0734 Skin Protection Wheelchair Seat Cushion, Adjustable, Width Less than 22 Inches, Any Depth
• K0735 Skin Protection Wheelchair Seat Cushion, Adjustable, Width 22 Inches or Greater, Any Depth
• K0736 Skin Protection and Positioning Wheelchair Seat Cushion, Adjustable, Width Less than 22 Inches, Any Depth
• K0737 Skin Protection and Positioning Wheelchair Seat Cushion, Adjustable, Width 22 Inches or Greater, Any Depth

(See the MLN Matters article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4267.pdf on the CMS Web site.)

The fee schedule amounts for the above codes, K0734, K0735, K0736, and K0737, are added to the fee schedule file on July 1, 2006 and are effective for claims submitted with dates of service on or after July 1, 2006.

HCPCS codes A6531 and A6532 were added to the HCPCS January 1, 2006, to replace L8110 and L8120; therefore, all billing and payment require­ments for HCPCS codes L8110 and L8120 crosswalk directly to A6531 and A6532, including the requirement to bill modifier AW when items are furnished for use as surgical dressings (see transmittal AB-03-100).

Implementation
The implementation date for the instruction is July 3, 2006.

Additional Information
The official instruction issued to your intermediary, carrier, or DMERC regarding this change can be found at http://www.cms.hhs.gov/Transmittals/downloads/R928CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare intermediary, carrier, or DMERC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: MM5017 Revised

Related Change Request (CR) #: 5017

Related CR Release Date: April 28, 2006
Effective Date: July 1, 2006
Related CR Transmittal #: R928CP

Implementation Date: July 3, 2006

Additional Information Provided by Empire Medicare Services (For Part A ONLY)
We have received clarification from CMS that the following codes are not priced yet on the DMEPOS file and therefore, rates are not available at this time:

HCPCS L0624, L0629, L0632, L0634, and L2232

In addition, HCPCS codes L6694 through L6698 now have fee rates effective from January 1, 2005. The CR states HCPCS codes L6694 and L6698 will be priced from January 1, 2005.