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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
- Clinical Trial Services and Modifiers Q0 and Q1

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

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Clarification—HCPCS Code E0571—Invalid

Effective for dates of service on or after February 4, 2011, HCPCS code E0571 (Aerosol compressor, battery powered, for use with small volume nebulizer) will be invalid for claim submission to the Jurisdiction B DME MAC. Suppliers providing battery-powered aerosol compressors should bill existing HCPCS code E0570 (Nebulizer, with compressor).

For dates of service prior to February 4, 2011, claims for code E0571 will continue to have LCA applied. Claims with dates of services on or after February 4, 2011 will be rejected as invalid coding.

Refer to the nebulizers LCD for additional coverage, coding and documentation requirements.

Note: Products previously coded E0571 by the PDAC contractor will be end dated on February 3, 2011 and will be listed with E0570 with an effective date of February 4, 2011. These products will be listed on the Product Classification List which is located on DMECS. DMECS is located on the PDAC Web site.

Current PA language for E0571

Code E0571 (Aerosol compressor, battery powered, for use with small volume nebulizer) is invalid for claim submission to Jurisdiction B DME MAC. Claims for E0571 will be rejected as invalid coding for dates of service on or after February 4, 2011.

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