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Policy Education Topics

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Ankle-Foot/Ankle-Knee-Foot Orthoses
- Ankle-Foot Orthoses: Arizona-Type Revised Correct Coding
- Ankle-Foot Orthoses: Walking Boots – Coverage and Coding Issues – Revised
- Correct Coding - Ankle Orthoses, With or Without Joints, Prefabricated or Custom Fabricated Coding Verification Review
- Billing Reminder: AFO/KAFO Prefabricated Base Orthoses and Custom-Fabricated Additions
- Charcot Restraint Orthotic Walker Coding Update
- Concentric Adjustable Torsion Joints – Correct Coding
- Orthoses: Replacement of Components Clarification
- Revised Coding Guidelines for Ankle-Foot Orthoses

Automatic External Defibrillators
- Coverage Reminder - Automatic External Defibrillators

Canes and Crutches

Continuous Passive Motion Devices
- Continuous Passive Motion Devices

Dear Physician Letter - Not Policy Specified
- Completion of Medicare Certificate of Medical Necessity
- Dear Physician: Implementation of ICD-10-CM/PCS
- Dear Physician Letter: Documentation
- Documentation of Continued Medical Necessity
- Face-to-Face and Written Order Requirements for High-Cost DME
- Face-to-Face and Written Order Requirements for Certain Types of DME

Documentation Best Practices
- Detailed Written Orders
- Face-to-Face Examination and Prescription Requirements Prior to the Delivery of Certain DME Items Specified in the Affordable Care Act - Revised
- ACA 6407 Requirements – Corrections and Amendments to the Face-To-Face Visit and Written Order Prior to Delivery
- Standard Documentation Language for Local Coverage Determinations and Related Policy Articles – Revised

External Breast Prostheses
- External Breast Prostheses Frequently Asked Questions
- Mastectomy Bra Billing Issues

External Infusion Pumps
- Billing for External Infusion Pumps and Drugs When Treatment Was Initiated Somewhere Other Than the Beneficiary’s Home
- Coverage and Correct Coding of Blincyto - Revised
- Coverage and Correct Coding of HyQvia® – Revised
- Coverage and Correct Coding of YONDELIS
- Correct Coding Reminder - Duopa® (AbbVie)
- External Infusion Pump LCD: Immune Globulin Subcutaneous (Human), 20% Liquid (Hizentra™)

Glucose Monitors and Supplies
- Billing for Glucose Supplies that Exceed Reasonable and Necessary Policy Parameters
- Documentation Compliance Review Common Errors for Glucose Testing Supplies
- Documentation Reminder - Glucose Monitor Logs for High-Utilization Claims

Hospital Beds and Accessories
- Billing Clarification on Support Surfaces and Hospital Beds
- Hospital Beds and Accessories—Physician Documentation
- Payment of Pressure Reducing Support Surfaces – KX, GA, or GZ Modifier Requirements
- Upgrade Billing for Hospital Beds Clarification

Immunosuppressive Drugs
- Dear Physician Letter: Immunosuppressive Drugs—Coverage Criteria and Physician Documentation Requirements
- Billing for Immunosuppressive Drugs

Knee Orthoses
- Coding Guidelines for Knee Orthoses Addition Codes

Lower Limb Orthoses
- Correct Coding – Definitions Used for Off-the-Shelf Versus Custom Fitted Prefabricated Orthotics (Braces) – Correction

Lower Limb Prostheses
- Dear Physician Letter: Documentation of Artificial Limbs
- Correct Coding - LIM innovations Infinite Socket™ - Revised
- Documentation for K Levels for Prosthetics
- Lower Limb Prostheses - Draft Policy DL33787

Manual Wheelchairs
- Billing Reminders for K0195 and E0988 with Manual or Power Wheelchairs
- Wheelchair Options and Accessories – LT and RT Modifiers – September 2010

National Coverage Determination Policy-Related Articles

Nebulizers
- Dear Physician Letter: Nebulizers—Coverage Criteria and Physician Documentation Requirements
- Billing Reminder: Nebulizers – Pharmacy Dispensing Fees for Inhalation Drugs
- Clarification—HCPCS Code E0571—Invalid
- Nebulizer Drugs Beneficiary Educational Letter
- Nebulizer Drugs Units of Service
- Reminder: Ultrasonic/Electronic Aerosol Generator With Small Volume Nebulizer – Coding Verification Review Requirement (A51447
- Ultrasonic/Electronic Aerosol Generator with Small Volume Nebulizer—Coding Verification Review Requirement

Negative Pressure Wound Therapy
- Negative Pressure Wound Therapy Billing Reminders

Oral Anticancer Drugs
- Correct Coding – Oral Anticancer Drugs and PDAC’s NDC/HCPCS Crosswalk Listings
- Coverage Issue for Physicians - Oral Anticancer Drugs
- Oral Anti-Cancer Drugs – Coding and Billing Change

Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
- Coverage and Coding - New Oral Antiemetic Drug Akynzeo - Revised
- Coverage and Coding - New Oral Antiemetic Drug Varubi® - Revised – Effective Date 7/1/2016
- Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics Policy) Clarification
- Oral Antiemetic Drugs: Coverage Reminder—November 2010 (A50451)

Oral Appliances for Obstructive Sleep Apnea
- Oral Appliances for Obstructive Sleep Apnea—New Medical Policy
- Oral Appliances for Obstructive Sleep Apnea—Billing Information (A49580)

Orthopedic Shoes
- Orthopedic Shoes - HCPCS Code L3000 Billing Reminder

Osteogenesis Stimulators

Ostomy and Ostomy Supplies
- Billing for Tape Codes (A4450 and A4452) and Modifiers (AU, AV and AW)

Oxygen and Oxygen Equipment
- Dear Physician Letter: Home Oxygen Initial Qualification Testing
- Documentation Requirements for Comprehensive Error Rate Testing Requests-Oxygen and Oxygen Equipment
- Frequently Asked Questions: Oxygen Use in Beneficiaries with Obstructive Sleep Apnea
- Oxygen and Oxygen Equipment
- Oxygen CMN: Completing the Length of Need
- Physicians: Are You Ordering Oxygen For Your Patient?
- Reminder – Oxygen Equipment and Contents Delivery
- Reminder Revised High Liter Flow Oxygen and Oxygen Equipment Payment and Billing Guidelines
- Reasonable Useful Lifetime Policies for Oxygen and Oxygen Equipment
- Revised: Payment Rules Reminder – Home Oxygen Initial Qualification Testing
- Submitting Oxygen CMNs Electronically When an ABG or Saturation Test is Not Present

Parenteral and Enteral
- Dear Physician Letter: Enteral Nutrition – CERT
- Correct Coding – NOC Codes for Enteral (B9998) and Parenteral (B9999) Nutrition
- Documentation and Billing Reminders for Enteral Nutrition Claims
- Specialty Enteral Formulas
- Updated External Infusion Pump Policy - Parenteral Inotropic Therapy FAQs

Pneumatic Compression Devices
- Correct Coding for Pneumatic Compression Devices

Positive Airway Pressure Devices
- Continuous (CPAP) Devices/Bi-Level Devices
- Diagnosis Requirements for Positive Airway Pressure Devices – Revised
- New Unprocessable Claim Rejections for Continuous Positive Airway Pressure Device (E0601)
- Physicians, Nurse Practitioners, Physician Assistants and Clinical Nurse Specialists - Are You Ordering Positive Airway Pressure Devices For Your Patient?
- Policy Reminder - Positive Airway Pressure Devices - Beneficiaries Entering Medicare
- Positive Airway Pressure Device - Diagnosis Required for Claim Submission
- Positive Airway Pressure Devices - Physician Frequently Asked Questions

Power Mobility Devices
- Dear Physician Letter: Documentation—Power Mobility Devices
- Complex Rehabilitation Repair Issues Frequently Asked Questions
- Correct Coding — Billing of HCPCS Code E0986
- Face-to-Face Examination Date on Seven-Element Order for Power Mobility Devices Scenarios
- Power Mobility Devices Frequently Asked Questions-Supplier ATP Involvement
- Power Wheelchair Electronics Clarification (A49991)
- Revised Power Mobility Device Independent Testing Requirements
- Upgrade Billing for Power Mobility Devices
- Upgrades to Group 2 Power Operated Vehicles (K0806–K0808) and Group 4 Power Wheelchairs (K0868–K0886)
- Wheelchairs Eligible for Advance Determination of Medicare Coverage - Group 4 Power Wheelchairs Removed (A51530)
- Wheelchair Options and Accessories – LT and RT Modifiers – September 2010

Refractive Lenses
- Refractive Lenses

Spinal Orthoses
- Correct Coding – Definitions Used for Off-the-Shelf Versus Custom-Fitted Prefabricated Orthotics (Braces) – Correction
- Spinal Orthoses—Coding Verification Review Requirement

Suction Pumps
- Correct Coding - ApniCure Winx® Sleep Therapy System

Support Surfaces
- Pressure Reducing Support Surfaces – Group II Billing Guide

Surgical Dressings
- Dear Physician Letter: Surgical Dressings—Coverage Criteria and Physician Documentation Requirements
- Correct Coding - Surgical Dressings Containing Unclassified Materials
- Revised Collagen Surgical Dressings - Coding Verification Review Requirement
- Surgical Dressing Order Requirements
- Surgical Dressings Documentation and Coding Requirements
- Surgical Dressings – Benefit Category Reminder

Therapeutic Shoes for Persons with Diabetes
- Coding Guidelines for Therapeutic Shoes for Persons with Diabetes
- Correct Coding – Medicare Coverage for Shoes
- Documentation Reminder—Therapeutic Shoes
- Therapeutic Shoes—Documentation Requirements
- Therapeutic Shoes: In-Person Fitting and Delivery (A49951)
- Therapeutic Shoes - Policy Revision/Documentation Requirements

Tracheostomy Supplies
- Billing for Tape Codes (A4450 and A4452) and Modifiers (AU, AV and AW)

Transcutaneous Electrical Nerve Stimulators
- Billing Reminders: Transcutaneous Electrical Nerve Stimulators and Supplies
- Correct Coding – BEMER Physical Vascular Therapy Devices
- Coverage Reminder – Transcutaneous Electrical Nerve Stimulators Used For Chronic Low Back Pain

Upper Limb Prostheses
- Hand-Finger Orthoses (L3923) - Use of CG Modifier - Revised

Urological and Urological Supplies
- Dear Physician Letter: Urological Supplies—Intermittent Catheterization
- Billing Reminder: Modifier Usage for Urological Supplies - Revised
- Correct Coding Instructions: A4358 Urinary Collection Bag
- Correct Coding - inFlow™ Intraurethral Valve-Pump (Vesiflo, Inc.)
- Correct Coding – “No-Touch” Catheters
- Urethral Inserts (A4336)—Coverage and Documentation (A50231)

Vacuum Erection Devices
- Vacuum Erection Devices – Noncovered by Medicare
- Vacuum Erection Devices (L7900)—Documentation Requirements

Ventilators
- Billing Reminder for Secondary Ventilators

Walkers
- Correct Coding – Weightless Walker

Ambulance Services
- Coverage of Rural Air Ambulance Services
- Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10
- Ambulance Transports Included in SNF Consolidated Billing
- Ambulance Transports Excluded from SNF Consolidated Billing
- Medical Necessity of Ambulance Services
- Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity

Billing
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Annual Wellness Visits ‑ Billing Tips for Physicians

Cardiac
- Reminder for Billing Cardiac Rehabilitation Session and Session Limitations

Chiropractic Services
- Chiropractic Maintenance Care
- Documentation to Support Spinal Manipulation for CPT Code 98942
- Limited Coverage for Services Ordered or Furnished By a Chiropractor
- Proper Billing for Acupuncture

Clinical Trials

Coding and Edits (Including MUEs)
- Adjustment of Claims with Automated Medical Review Denials
- Site of Service Codes for Continuous Home Care and General Inpatient Care Level of Service
- Medically Unlikely Edits Billing and Processing
- Counseling to Prevent Tobacco Use
- National Coverage Determination 190.3 - Cytogenetic Testing: Discretionary Diagnoses

Diabetes Related
- Diabetic Supplies Beneficiary Educational Letter
- Medicare Diabetes Prevention Program

Documentation
- Documentation Required for Home Visits
- Capable Recipients for the Advance Beneficiary Notice of Noncoverage
- Change Request 6698 (Revised): Signature Guidelines for Medical Review Purposes
- Cloned Documentation Could Result in Medicare Denials for Payment
- Missing or Illegible Signatures/Signature Requirements
- Hardcopy Order and Progress Note Signature Guidelines/Attestation Sample
- Submitting Electronic Medical Records
- Tips for Responding to a Hospice ADR
- Therapy Reassessment
- Skilled Nursing Facility Medicare Part A Benefit Quick Reference Fact Sheet
- Scribing Medical Record Documentation
- Assistant at Surgery Billing Documentation Reminder
- Primary Care Exception Guidelines

Drugs and Vaccines
- Providers Performing Facet Joint Injections (CPT Code 64476)
- Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview
- Testosterone Pellet Dosage

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
- Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Evaluation and Management
- CMS Evaluation and Management Services Guide
- Critical Care Services: CPT Codes 99291-99292
- Definition of New Patient for Billing Evaluation and Management Services
- Evaluation & Management Documentation Training Tool
- Evaluation and Management Frequently Asked Questions
- Evaluation and Management Services: 1995 Documentation Guidelines
- Evaluation and Management Services: 1997 Documentation Guidelines
- Low Vision Services
- Nonphysician Practitioners: Evaluation and Management Services
- Prolonged Services: Face-to-Face
- Prolonged Services: Non-Face-to-Face
- Prolonged Services: Comparative Differences of Face-to-Face/Non-Face-to-Face CPT Codes
- Time-Based Evaluation and Management Services
- Tip Sheet: Proper Use of Modifier 25
- General E/M Information
- Documentation
- History
- Examination
- Medical Decision Making
- Admission and Discharge Services
- Split/Shared and Incident To Services
- Observation Services
- Consultations
- Time Based Services
- Prolonged Services
- Chronic Care Management
- Critical Care Services
- IPPE and AWV
- Provider Specialty
- Teaching Environment E/M Services
- Scribes
- Fee-For-Time Compensation Arrangements
- New vs. Established Patients
- Emergency Department
- Separately Identifiable Service
- Global Period Services
- Behavioral Health Services
- Transitional Care Management
- Smoking Cessation
- Advanced Care Planning
- Modifiers
- Urgent Care
- Preoperative Clearance

Global Surgery
- Global Surgery

Hospice Benefit

Psychiatric Services

Home Health Benefit
- Initial Episode Clarified for Home Health Face-to-Face Encounter

Incident To Services
- Incident to Quick Reference Chart
- “Incident to” Services
- Incident to Job Aid for Place of Service Office
- Incident to Office Guidelines

IPPE and AWV
- The Annual Wellness Visit

Laboratory Services
- Medicare Coverage for Zika Virus Testing

Mental Health Services
- Signature Requirements

Modifiers
- Anesthesia Modifiers
- Correct Usage of Modifier 79 for Multiple Procedures
- Modifier 25
- Modifier 52
- Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, TI-T9 and TA vs. Modifier 50
- Modifier 90 (Reference to Outside Laboratory)
- Modifier 51
- Modifier 33
- Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
- Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
- Assistants at Surgery at Teaching Hospitals

Opioid Epidemic in America
- Opioid Epidemic Newsletters
- Resources and Related Information
- Opioid Treatment Program

Osteopathic

Organ Transplant
- Medicare Coverage for Living Organ Transplant Donors

Outpatient Observation Services
- Outpatient Observation Services: Reporting Time Correctly

Outpatient Therapy Functional Reporting
- Outpatient Therapy Functional Reporting

Radiology Services
- Nonphysician Practitioner Scope of Practice for Radiology Services Within Illinois, Minnesota and Wisconsin

RuralServ
- NGS RuralServ
- NGS RuralServ
- NGS RuralServ
- NGS RuralServ
- NGS RuralServ
- NGS RuralServ

Social Determinants of Health
- Social Determinants of Health – House Calls
- Social Determinants of Health – Environmental Influences

Web Content Viewer

Lower Limb Prostheses – Draft Policy DL33787

Joint DME MAC Publication

On 11/2/2015 the CMS announced the convening of an inter-agency panel to address clinical questions associated with the provision of lower limb prostheses. The DME MACs are delaying finalization of the draft Proposed/Draft Lower Limb Prostheses (DL33787) pending the final report of the panel.

Additional information is available on the CMS website.

Policy Education Topics

Lower Limb Prostheses – Draft Policy DL33787

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