MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
|
Annual Update
of HCPCS Codes Used for Home Health (HH) Consolidated
Billing Enforcement
Provider Types Affected
Physicians, providers, home health agencies (HHAs), and
suppliers
Provider Action Needed
The
Centers for Medicare & Medicaid Services (CMS)
periodically updates the lists of HCPCS codes subject to
the consolidated billing provision of the Home Health
Prospective Payment System (HH PPS). This article
provides the annual HH consolidated billing update
effective January 1, 2005. Affected providers should be
aware of these changes.
Background
Section 1842(b)(6)
of the Social Security Act (SSA) requires that payment
for home health services provided under a home health
plan of care be made to the HHA. As a result, billing for
all such items and services is to be made by a single HHA
overseeing that plan. This HHA is known as the primary
agency for HH PPS for billing purposes.
With the exception of therapies performed by
physicians, supplies incidental to physician services,
and supplies used in institutional settings, services
appearing on this list that are submitted on claims to
Medicare contractors will not be paid separately on dates
when a beneficiary for whom such a service is being
billed is in a home health episode (i.e., under a home
health plan of care administered by an HHA).
Medicare periodically publishes Routine Update
Notifications, which contain updated lists of non-routine
supply and therapy codes that must be included in HH
consolidated billing. The lists are always updated
annually, effective January 1, as a result of changes in
HCPCS codes that Medicare also publishes annually. This
list may also be updated as frequently as quarterly if
required by the creation of new HCPCS codes during the
year.
Additional Information
This
notification provides the annual HH consolidated billing
update effective January 1, 2005. The following table
describes the HCPCS codes and the specific changes to
each that this notification is implementing on January 3,
2005:
|
Code
|
Description of Code
|
Type Change
|
Replacement Code or Code Being
Replaced
|
|
Non-Routine Supplies
|
|
|
|
|
A4347
|
Male external catheter
|
Delete
|
Replacement code: A4349
|
|
A4324
|
Male ext cath w/adh coating
|
Delete
|
Replacement code: A4349
|
|
A4325
|
Male ext cath w/adh strip
|
Delete
|
Replacement code: A4349
|
|
A4349
|
Male ext catheter, with or without adhesive,
disposable, each
|
Add
|
Replaces codes: A4347, A4324, A4325
|
|
A7040
|
One way chest drain valve
|
Add
|
|
|
A7041
|
Water seal drainage container and tubing for use
with implanted chest tube
|
Add
|
|
|
A7045
|
Exhalation port with or without swivel used with
accessories for positive airway devices,
replacement only
|
Add
|
|
|
A7527
|
Tracheostomy/laryngectomy tube plug/stop,
each
|
Add
|
|
|
Therapies
|
|
|
|
|
97601
|
Wound care selective
|
Delete
|
Replacement codes: 97597, 97598
|
|
97597
|
Removal of devitalized tissue from wound(s),
selective debridement; surface area less than or
equal to 20 square centimeters
|
Add
|
Replaces code: 97601
|
|
97598
|
Removal of devitalized tissue from wound(s),
selective debridement; total wound(s) surface area
greater than 20 square centimeters
|
Add
|
Replaces code: 97601
|
|
97605
|
Negative pressure wound therapy (e.g., vacuum
assisted drainage collection); total wound(s)
surface area less than or equal to 50 square
centimeters
|
Add
|
|
|
97606
|
Negative pressure wound therapy (e.g., vacuum
assisted drainage collection); total wound(s)
surface area greater than 50 square centimeters
|
Add
|
|
The last update to the HH consolidated billing was
issued under Transmittal 226, CR 3350. This CR can be
found at: http://www.cms.hhs.gov/Transmittals/downloads/R226CP.pdf
.
The official instruction issued to your
carrier/intermediary (including Durable Medical Equipment
Carriers (DMERCs) and Regional Home Health Intermediaries
(RHHIs)) regarding this change may be found by going to:
http://www.cms.hhs.gov/Transmittals/
.
From that Web page, look for CR 3525 in the CR NUM
column on the right, and click on the file for that
CR.
If you have any questions regarding this issue, please
contact your carrier/intermediary at their toll-free
number, which may be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf
.
Disclaimer
The information contained in this
article was current at the time of its development. We
encourage users of this article to review statutes,
regulations, and other interpretive materials for the
most current information.
Additional Information Provided by Empire
Medicare Services
The HH consolidated
billing master code list is available at the following
Internet address: http://www.cms.hhs.gov/providers/hhapps/#billing.
For more information, visit the Medlearn Matters Web
page at: http://www.cms.hhs.gov/MedlearnMattersArticles/.
Pub. 100-4, Transmittal # 340, CR # 3525
Medlearn Matters Number: MM3525
Effective Date: January 1, 2005
Implementation Date: January 3, 2005
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