Tag: Coding
Noridian responds to orthotics inquiries
September 23, 2024HME News Staff
WASHINGTON – Noridian Healthcare Solutions has published an update for billing custom-fitted orthotics when no custom fitting is completed with no off-the-shelf equivalent available. “Due to recent inquiries from suppliers, it has come to our attention that some miscellaneous codes used for billing off-the-shelf orthotics, when a custom fit orthotic is provided but no custom fitting is performed, may require specific policy and laterality modifiers,” it states. These claims must...
Tactile secures coding for Nimbl
September 17, 2024HME News Staff
MINNEAPOLIS – Tactile Systems has announced that the Pricing, Data Analysis and Coding (PDAC) contractor for CMS has approved the use of HCPCS code E0651 to bill for its Nimbl pneumonia compression platform. The PDAC’s approval follows the company’s 510(k) clearance from the U.S. Food and Drug Administration in June. “The receipt of PDAC approval for Nimbl comes earlier than expected, and we are pleased that CMS recognizes the potential health and quality-of-life enhancing...
CMS proposes coding changes for intermittent urinary catheters
May 6, 2024HME News Staff
WASHINGTON – CMS has proposed discontinuing two existing HCPCS codes for intermittent urinary catheters, A4351 and A4352, and establishing five new codes in response to a request from AAHomecare and its manufacturer members.
The agency stated that it does not see a claims processing need to discontinue or modify existing HCPCS code A4353, “Intermittent urinary catheter, with insertion supplies.”
“CMS believes that clinical evidence and current payer policies...
Stakeholders on seat elevation: ‘We need more details’
March 20, 2024Liz Beaulieu, Editor
WASHINGTON – Complex rehab stakeholders are disappointed in CMS’s payment rate for seat elevation systems and have requested a meeting with the agency to learn more about how it landed on about $2,000.
That rate is lower than the $2,800, on average, that providers are being paid for the systems on an interim basis, and significantly lower than the rate stakeholders had recommended.
“The payment piece was disappointing,” said Wayne Grau, executive director...
CMS releases coding, payment info for seat elevation systems
March 4, 2024HME News Staff
WASHINGTON – CMS has announced coding and payment information for seat elevation systems for complex rehab power wheelchairs, AAHomecare has reported.
The key takeaways, according to the association:
Discontinues existing HCPCS Level II code E2300, “Wheelchair accessory, power seat elevation system, any type,” effective March 31, 2024
Establishes E2298, “Complex rehabilitative power wheelchair accessory, power seat elevation system, any...
CMS releases coding plan for power seat elevation
November 13, 2023HME News Staff
WASHINGTON – CMS has issued preliminary recommendations for coding and pricing for power seat elevation systems, NCART has reported.
The recommendations include discontinuing the existing HCPCS Level II code E2300, “wheelchair accessory, power seat elevation system, any type,” and establishing two new HCPCS Level II codes at a set fee schedule amount:
EXXXX, “complex rehabilitative power wheelchair accessory, power seat elevation system, any type”
EXXXX,...
AdvancedMD releases codebook
March 6, 2023HME News Staff
SOUTH JORDAN, Utah – AdvancedMD, a software provider, has released its 2023 CPT/HCPCS Codebook. The resource includes the full list of updated CPT/HCPCS codes, identifying which medical codes have been added, revised and deleted by CMS. “Billing errors are an expensive mistake, equating to approximately $125 billion in uncollected money each year,” said Tim Constantino, vice president and head of product at AdvancedMD. “Not only do incorrect codes result in massive bill collection...
van Halem Group adds thought-leader
July 27, 2021HME News Staff
ATLANTA – The van Halem Group has announced that Dr. Doran Edwards has joined its team as a medical advisor. Edwards recently retired after three years with Palmetto GBA, where he was the medical director for the Pricing, Data Analysis and Coding contractor. He was also the medical director of the SADMERC, the predecessor to the PDAC from 2003-08. “Over the last few years, the van Halem Group has been working with manufacturers as they bring new products to market and need to navigate...
CMS schedules coding meeting
March 7, 2019HME News Staff
BALTIMORE, Md. - CMS will hold the annual Healthcare Common Procedure Coding System (HCPCS) Coding and Payment Determinations public meeting for DMEPOS on June 11-12, 2019. The meeting provides an opportunity to discuss coding and payment determinations for all new requests for revisions to the HCPCPS codes. Interested parties can make oral presentations or submit written comments. Registration information will be available at a later date.
Contract switches to Palmetto GBA
January 2, 2019HME News Staff
COLUMBIA, S.C. - Palmetto GBA is taking over as the Pricing, Data Analysis and Coding (PDAC) contractor this month. The PDAC receives, evaluates and processes coding verification applications for DMEPOS; establishes, maintains and updates all coding verification decisions on the product classification list; provides coding guidance for manufacturers and suppliers on the proper use of HCPCS; maintains and publishes the NDC/HCPCS crosswalk and OACD pricing files; and conducts DMEPOS data analysis....