Reimbursement guide for LTV series ventilators
®
Table of contents
Section I: Reimbursement essentials........................................................................................................................................................................................................ 1
General Medicare information....................................................................................................................................................................................................................... 1
Centers for Medicare and Medicaid (CMS): Regional offices.......................................................................................................................................................................... 2
General information on coding, coverage and payment................................................................................................................................................................................. 3
Section II: Sites of service—home, LTACH and SNF................................................................................................................................................................................ 5
Site of service................................................................................................................................................................................................................................................ 5
Home............................................................................................................................................................................................................................................................ 5
LTACH........................................................................................................................................................................................................................................................... 7
SNF............................................................................................................................................................................................................................................................. 8-9
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Section III: Coverage, coding and payment for LTV ventilators..........................................................................................................................................................10
Process for utilizing the LTV series ventilators................................................................................................................................................................................................10
Site of service...............................................................................................................................................................................................................................................11
Home...........................................................................................................................................................................................................................................................11
LTACH..........................................................................................................................................................................................................................................................15
SNF...............................................................................................................................................................................................................................................................15
Section IV: Coding verification competitive products...........................................................................................................................................................................17
Coding verification.......................................................................................................................................................................................................................................17
Section V: Accessory coding and payment.............................................................................................................................................................................................18
How are accessories to ventilators coded and paid?.....................................................................................................................................................................................18
Glossary of Medicare terms.....................................................................................................................................................................................................................19
Abbreviations and acronyms...................................................................................................................................................................................................................20
Helpful reimbursement website..............................................................................................................................................................................................................21
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Section I—Reimbursement essentials
The practice of medical billing and reimbursement is very complex. Home Medical Equipment (HME), Long-Term Acute Care (LTAC) and Skilled Nursing Facilities (SNF)
providers alike must stay abreast of coding changes, develop sound billing practices and provide supporting documentation along every step of the way. To expedite
the reimbursement process, all claims should be submitted with the proper information, including initial consultation, history and physical (H&P) and diagnostic findings.
Appropriate use of the ICD-9- CM codes and HCPCS Level I and II codes will help minimize denials due to lack of documentation or improper billing. Additionally, providers
may elect to routinely contact insurance carriers for pre-authorization prior to providing service. HMEs may check http://www.dmepdac.com for information related to
product listings under appropriate HCPCS codes and/or to code search.
General Medicare information
The Centers for Medicare and Medicaid Services (CMS) is the agency located
Part B Medical Insurance: Most people pay a monthly premium for Part B.
in Baltimore, Maryland that administers the Medicare and Medicaid programs.
Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient
Medicare was enacted under the 1965 Amendments to the Social Security Act. .
care. It also covers some other medical services that Part A doesn’t cover, such
It was formerly called the Health Care Financing Administration (HCFA).
as some of the services of physical and occupational therapists, and some home
Medicare is the federal health insurance program for:
• People age 65 or older
• People under age 65 with certain disabilities
• People of all ages with end-stage renal disease (permanent kidney failure requiring
dialysis or a kidney transplant)
Parts of the Medicare program and coverage
healthcare. Part B helps pay for these covered services and supplies when they are
medically necessary.
Part D Prescription Drug Coverage: Most people will pay a monthly premium for
this coverage. Starting January 1, 2006, new Medicare prescription drug coverage
was available to everyone with Medicare. Everyone with Medicare can get this
coverage that may help lower prescription drug costs and help protect against
higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private
companies provide the coverage. Beneficiaries choose the drug plan and pay a
Part A Hospital Insurance: Most people do not pay a premium for Part A because
monthly premium. Like other insurance, if a beneficiary decides not to enroll in .
they or a spouse already paid for it through their payroll taxes while working.
a drug plan when they are first eligible, they may pay a penalty if they choose to
Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including
join later.
critical access to hospitals and skilled nursing facilities (not custodial or long-term
care). It also helps cover hospice care and some home healthcare. Beneficiaries must
meet certain conditions to get these benefits.
1
Centers for Medicare and Medicaid (CMS): Regional offices
The Centers for Medicare and Medicaid have 10 separate regional offices that provide state-specific information on Medicare, Medicaid and SCHIP programs. Region I: Connecticut, Maine, Massachusetts, New Hampshire,
Region VI: Arkansas, Louisiana, New Mexico, Oklahoma and Texas
Rhode Island and Vermont.
Centers for Medicare & Medicaid Services (CMS): Region VI
Centers for Medicare & Medicaid Services (CMS): Region I
1301 Young Street, Suite 714.
JFK Federal Building.
Dallas, TX 75202.
Room 2325.
Phone: 214.767.6423
Boston, MA 02203.
Region VII: Iowa, Kansas, Missouri and Nebraska
Phone: 617.565.1185
Region II: New York and New Jersey
Richard Bolling Federal Building, Room 235.
Centers for Medicare & Medicaid Services (CMS): Region II
601 East 12th Street.
26 Federal Plaza, 38th Floor.
Kansas City, MO 64106.
New York, NY 10278.
Phone: 816.426.5233
Phone: 212.264.3657
Region VIII: Colorado, Montana, North Dakota, South Dakota, Utah
Region III: Delaware, Maryland, Pennsylvania, Virginia, West Virginia
and Wyoming.
and the District of Columbia.
Centers for Medicare & Medicaid Services (CMS): Region VIII
Centers for Medicare & Medicaid Services (CMS): Region III
Colorado State Bank Building.
Public Ledger Building, Suite 216.
1600 Broadway, Suite 700.
150 South Independence Mall West.
Denver, CO 80202.
Philadelphia, PA 19106.
Phone: 303.844.2111
Phone: 215.861.4140
Region IX: Arizona, California, Hawaii and Nevada
Region IV: Alabama, North Carolina, South Carolina, Florida, Georgia,
Centers for Medicare & Medicaid Services (CMS): Region IX
Kentucky, Mississippi and Tennessee.
75 Hawthorne St., Suite 408.
Centers for Medicare & Medicaid Services (CMS): Region IV
San Francisco, CA 94105.
Atlanta Federal Center.
Phone: 415.744.3501
61 Forsyth Street, S.W., Suite 4T20.
Atlanta, GA 30303-8909.
Phone: 404.562.7500
2
Centers for Medicare & Medicaid Services (CMS): Region VII
Region X: Alaska, Idaho, Oregon and Washington
Centers for Medicare & Medicaid Services (CMS): Region X
2201 Sixth Avenue, Suite 911.
Region V: Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin
Seattle, WA 98121.
Centers for Medicare & Medicaid Services (CMS): Region V
Phone: 206.615.2306.
233 North Michigan Avenue, Suite 600.
.
Chicago, IL 60601.
More information on the individual regional offices can be obtained from
Phone: 312.886.6432
the Centers for Medicare and Medicaid website at http://www.cms.gov.
Medicare Administrative Contractors (MACs)
– May be standalone or bundled
These are private insurers under contract with CMS for provider/supplier enrollment,
– May be driven by breakthrough or existing technologies
claims payment and appeals. There are two different entities:
General information about coding
• A/B MACs are transitioning from Fiscal Intermediaries and Part B Carriers and
The Healthcare Common Procedural Coding System (HCPCS) provides a standardized
cover 15 distinct areas.
• DME MACS cover four distinct regions and process Durable Medical Equipment
(DME) products and supplies (more details under Site of service: Home). The
beneficiary’s residence determines which DME MAC processes the claim.
system for billing Medicare for drugs, devices or procedures.
HCPCS consists of:
• Level I Current Procedure Terminology (CPT) codes • Level II national codes
General information regarding coding, coverage
and payment
Definitions:
Coverage: Terms and conditions for payment
Coding: Unique identifiers for diagnoses, procedures, devices & diagnostics,
HCPCS codes must be used when billing Medicare carriers and, in some states,
when billing Medicaid carriers. Due to HIPAA, HCPCS codes are the national code
set and used by all insurance carriers.
Level I codes: HCPCS mainly consists of CPT codes. These five-digit codes provide a
standardized means of reporting services or procedures performed by a physician.
inpatient services and outpatient services
Level II codes: Codes describe drugs and devices and those services not covered in
Payment: Remuneration by health insurance plans, government-funded programs
Level I. Most DME products, including those used for ventilators, are billed with a
The difference between these concepts
• Coverage – Is not guaranteed when you receive FDA approval/clearance
– Does not guarantee a new or favorable billing code
– Does not guarantee favorable reimbursement
• Coding
– Links coverage and payment
– Does not guarantee coverage
– Does not guarantee favorable reimbursement
Level II code.
What are the Place of Service (POS)/Site of Service (SOS) codes?
• HIPAA qualified Medicare as a covered entity and thus, as a covered entity,
must use the place of service (POS) codes from the National POS code set for
processing its electronically submitted claims.
• POS has a payment rate designation of F for facility and NF .
for nonfacility.
How does the SOS payment policy affect provider payments?
• Providers billing professional services are paid at one of two maximum allowable
fees, depending on where the service is performed.
• Payment
– Function of coverage and coding
– May be subject to limits
3
General information about coverage
Overview
Medicare provides coverage for items and services for more than 43 million
beneficiaries. The vast majority of coverage is provided on a local level and
developed by medical directors and the contractors that pay Medicare claims.
In some cases, Medicare deems it appropriate to develop a National Coverage
product is being used. Each site of service will be discussed in the respective sections
of this manual.
How are the payment amounts for CPT Level I codes established for
professional services performed in facility and non-facility settings?
• Based on the Resource-Based Relative Value Scale (RBRVS) methodology, .
Determination (NCD) for an item or service to be applied on a national basis for .
CPT fee schedule amounts are established using three relative value unit .
all Medicare beneficiaries meeting the criteria for coverage.
(RVU) components: Medicare coverage is limited to items and services that are reasonable and necessary
1. Work
for the diagnosis or treatment of an illness or injury (and within the scope of a
2. Practice expense
Medicare benefit category). National coverage determinations (NCDs) are made
3. Malpractice expense
through an evidence-based process, with opportunities for public participation.
In some cases, CMS’ own research is supplemented by an outside technology
• Two levels of practice expense components determine the fee schedule amounts
assessment and/or consultation with the Medicare Evidence Development &
for reimbursing professional services. This may result in two RBRVS maximum
Coverage Advisory Committee (MEDCAC). In the absence of a national coverage
allowable fees for a procedure code. These are:
policy, an item or service may be covered at the discretion of the Medicare
contractors based on a local coverage determination (LCD).
• Medical necessity: Services or supplies that are proper and needed for the
diagnosis or treatment of a medical condition; are provided for the diagnosis,
direct care and treatment of a medical condition; meet the standards of good
medical practice in the local area and aren’t mainly for the convenience of the
patient or physician. Medical necessity is established by answering the “why”
question: “Why” does the patient require this therapy/equipment?
• Certificate of Medical Necessity (CMN): A form required by Medicare that allows
the patient to use certain durable medical equipment prescribed by the physician
or one of the physician’s office staff. It documents the “Why does the patient
require this equipment” question.
General information about payment
Each site of service has its own payment structure:
• Home
• LTACH
4
Therefore, reimbursement for ventilators may vary based on the setting in which the
• SNF
1. Facility setting maximum allowable fees (FS fee): Paid when the provider
performs the services in a facility setting (e.g., a hospital or ambulatory surgery
center). The cost of the resources are the responsibility of the facility.
2. Non-facility setting maximum allowable fees (NFS fee): Paid when the provider
performs the service in a non-facility setting (e.g., office or clinic), and typically
bears the cost of resources, such as labor, medical supplies and medical
equipment associated with the service performed.
• Some services, by nature of their description, are performed only in certain
settings and have only one maximum allowable fee per code. Examples of these
services include:
1.Evaluation and management (E&M) codes, which specify the site-of-service
(SOS) within the description of the procedure codes (e.g., initial hospital care).
2.Major surgical procedures that are generally performed only in hospital settings.
Section II—Sites of service—home, LTACH and SNF
1. Site of service: Home
Durable Medical Equipment Medicare Administrative Contractors (DMEMACs)
In an effort to provide greater efficiency in the Medicare program as it applies to Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), CMS awarded
contracts to four insurance carriers who serve as its contractors, known as Durable Medical Equipment Medicare Administrative Contractors (DME MACs). Among their
many responsibilities are processing claims as well as writing local coverage policies for DMEPOS.
Each DME MAC covers a specific geographic region of the country, noted below, and only processes Medicare claims for DMEPOS items. CMS has established a very
informative section on its website especially for coding, coverage and payment issues related to DMEPOS, http://www.cms.gov/center/dme.asp. You may also get more
information by calling 800.MEDICARE (800.633.4227).
Jurisdiction A: Connecticut, Delaware, Maine, Massachusetts, New Hampshire,
Jurisdiction C: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana,
New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Washington, DC.
Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina,
NHIC, Corp. National Heritage Insurance Company
Tennessee, Texas, U.S. Virgin Islands, Virginia and West Virginia
75 Sgt. William Terry Drive
Cigna Government Services CGS Administrators, LLC
Hingham, MA 02043
2 Vantage Way
DME Customer Service (IVR): 866.419.9458
Nashville, TN 37202 DME Customer Service: 866.590.6731
DME Customer Service (IVR): 866.238.9650
http://www.medicarenhic.com
DME Customer Service: 866.270.4909
Medical Director: Dr. Paul Hughes
http://www.cgsmedicare.com
Jurisdiction B: Illinois, Indiana, Kentucky, Michigan, Minnesota,
Medical Director: Dr. Robert Hoover
Ohio and Wisconsin.
Jurisdiction D: Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri,
National Government Services, Inc.
Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah,
8115 Knue Road
Washington, Wyoming, American Samoa, Guam and N. Mariana Islands.
Indianapolis, IN 46250
Noridian Administrative Services, LLC.
DME Customer Service (IVR): 877.299.7900
900 42nd Street South
DME Customer Service: 866.590.6727
Fargo, ND 58103-2146
http://www.ngsmedicare.com/ngsmedicare/HomePage.aspx
DME Customer Service (IVR): 877.320.0390 or [email protected]
Medical Director: Dr. Stacey Brennan
DME Contact Center: 866.243.7272
http://www.noridianmedicare.com
Medical Director: Dr. Richard Whitten
5
Medicare pricing, data analysis and coding (DME PDAC)
Who administers the program?
What is the HCPCS review or coding verification process?
• Noridian Administrative Services, LLC (NAS) is the insurance company located
HCPCS review or coding verification process is the process that allows
in Fargo, North Dakota who contracts with CMS to serve as the Pricing,
Data Analysis and Coding (PDAC) Contractor. It performs the activities
that Palmetto GBA Statistical Analysis DME Regional Carrier (SADMERC)
performed prior to August 2008.
• Website is http://www.dmepdac.com.
What are the functions of the PDAC?
manufacturers, distributors and other parties to request a coding decision
on a DMEPOS item. A Coding Verification Request form and supporting
documentation is submitted to the PDAC staff for review and a decision.
Manufacturers use this process to verify that their particular DMEPOS product
falls into a particular HCPCS code. The process takes usually 90 days and the
PDAC will issue a coding verification letter to the manufacturer stating that its
product falls into a particular HCPCS code. The PDAC will then list it with the
DMEC program.
• Provides data analysis support to the DME Program Safeguard .
Contractors (PSCs).
• Guides manufacturers and suppliers on the proper use of the HCPCS
through product reviews and decisions.
• Conducts national pricing functions for DMEPOS services.
Available resources
• Assists CMS with DMEPOS fee schedules.
The PDAC website includes resources to assist manufacturers, distributors and
How does the DMEC program on the PDAC website help manufacturers
suppliers in coding DMEPOS products and provides information on HCPCS
and suppliers?
changes. This includes advisory articles, previously published by the Statistical
The PDAC supplies a web-based application that provides HCPCS coding
In addition, they provide related DME and HCPCS websites and information
assistance and national pricing information via searches for HCPCS Level II
about the Comprehensive Error Rate Testing program to help prevent coding
codes and modifiers, DMEPOS and CMS national fee schedules on its website.
errors. All PDAC questions should be directed to:
There are four interactive components that work together to provide HCPCS .
PDAC Contact Center
coding information:
http://www.dmepdac.com
Analysis DME Regional Carrier (SADMERC), and those published by the PDAC.
Toll free: 877.735.1326 • Search by HCPCS information
Direct: 701.433.3077 • Search by modifier
Fax: 866.209.1236 • Search by fee schedule
• Search by DMEPOS product classification list
Hours: 8:30 a.m. to 4 p.m. CT
Mailing address:Pricing, Data Analysis and Coding, .
PO Box 6757, Fargo, ND 58108-6757
Courier address:Pricing, Data Analysis and Coding,
6
900 42nd Street, South Fargo, ND 58108-6757
Coverage in the home care setting
Long-term acute care facility structure
Coverage for DMEPOS is either governed by a national coverage determination
• Level 1 services: Long-term acute care (LTAC) services provided to clients
(NCD), which would apply in all states, or by local coverage determinations (LCD).
who require more than eight hours of direct skilled nursing care per day. .
The national coverage determinations can be found on the CMS website (http://
Level 1 services include one or both of the following:
www.cms.gov/medicare-coverage-database). The local coverage determinations can
be found on each one of the DME MAC websites listed above and in the Appendix
section of this manual. More information about ventilators will be found in Section
III of this manual.
A national coverage determination (NCD) does exist for ventilators and thus applies
to all states.
Ventilators: Covered for treatment of neuromuscular diseases, thoracic restrictive
- Active ventilator weaning care and any specialized therapy services, such as
physical, occupational and speech therapies
- Complex medical care that may include:
+ Care for complex draining wounds
+ Care for central lines
+ Multiple medications (intravenous)
diseases and chronic respiratory failure consequent to chronic obstructive pulmonary
+ Frequent assessments and close monitoring
disease. Includes both positive and negative pressure types. (See §240.5 of the .
+ Third degree burns that may involve grafts and/or frequent transfusions
NCD Manual.)
Payment in the home care setting
Medicare payment for DME, prosthetics and orthotics (P&O), parenteral and enteral
+ Specialized therapy services, such as physical, occupational and .
speech therapies
• Level 2 services: Long-term acute care (LTAC) services provided to clients who
nutrition (PEN), surgical dressings and therapeutic shoes and inserts is equal to 80%
require four to eight hours of direct skilled nursing care per day. Level 2 services
of the lower of either the actual charge for the item or the fee schedule amount
include at least two of the following:
calculated for the item, less any unmet deductible. The beneficiary is responsible
for 20% of the lower of either the actual charge for the item or the fee schedule
amount calculated for the item, plus any unmet deductible.
We have included specific payment information regarding ventilators and accessories
in Section III of this manual.
2. Site of service: Long-term acute care (LTAC)
- Ventilator care for clients who are stable, dependent on a ventilator and have
complex medical needs
- Care for clients who have: tracheostomies, complex airway management and
medical needs, and the potential for decannulation
- Specialized therapy services, such as physical, occupational and .
speech therapies
Medical Assistance Administration (MAA) approved LTAC facilities provide inpatient
intensive long-term acute care services to eligible Medical Assistance clients who
require the following Level 1 or Level 2 services.
7
LTAC PPS
*MAA pays the LTAC facility the LTAC fixed per diem rate in effect at the time the
LTAC services are provided, minus the sum of:
• Client liability, whether or not collected by the provider
• Any amount of coverage from third parties, whether or not collected by the
provider, including, but not limited to, coverage from:
- Insurers and indemnitors
- Other federal or state medical care programs
- Payments made to the provider on behalf of the client by individuals or
organizations not liable for the client’s financial obligations
- Any other contractual or legal entitlement of the client, including, but .
covers certain skilled care services that are needed daily on a short-term basis .
(up to 100 days).
• Skilled care requires the involvement of skilled nursing or rehabilitative staff so .
to be certain it is given safely and effectively. Skilled nursing and rehabilitation
staff includes:
- Registered nurses
- Licensed practical and vocational nurses
- Physical and occupational therapists
- Speech-language pathologists - Audiologists
not limited to:
Per diem PPS, CB and RUG categories
+ Crime victims’ compensation
The Balanced Budget Act of 1997 mandated the implementation of a per diem
+ Workers’ compensation
prospective payment system (PPS) for SNFs covering all costs (routine, ancillary
+ Individual or group insurance
+ Court-ordered dependent support arrangements
+ The tort liability of any third party
*Note: MAA may make annual rate increases to the LTAC fixed per diem rate by
using the same inflation factor and date of rate increase that MAA uses for acute
care hospital diagnostic-related group (DRG) rates.
3. Site of service: Long-term acute care (LTAC)
Skilled nursing facilities structure
• Skilled care is healthcare given when skilled nursing or rehabilitation is needed
to treat, manage, observe and evaluate care. Examples of skilled care include:
intravenous injections and physical therapy.
• It is care given in a skilled nursing facility (SNF) by professional staff.
- Non-professional staff is not considered skilled care.
8
• Usually people do not stay in a SNF until they are completely recovered. Medicare
and capital) related to the services furnished to beneficiaries under Part A of the
Medicare program. Major elements of the system include:
Rates: Federal rates were set using allowable costs from FY 1995 cost reports.
The rates also include an estimate of the cost of services which, prior to July 1,
1998, had been paid under Part B but furnished to SNF residents during a Part
A covered stay. FY 1995 costs were updated to FY 1998 by a SNF market basket
minus one percentage point for each of fiscal years 1996, 1997 and 1998. Providers
that received new provider exemptions in FY 1995 were excluded from the
database. Routine cost limit exceptions payments were also excluded. The data was
aggregated nationally by urban and rural area to determine standardized federal per
diem rates to which case mix and wage adjustments applied.
Case mix adjustment: Per diem payments for each admission are case-mix adjusted
using a resident classification system (Resource Utilization Groups III or RUG) based
on data from resident assessments (Minimum Data Sets or MDS 2.0) and relative
weights developed from staff time data.
Geographic adjustment: The labor portion of the federal rates is adjusted for
Conceptually, SNF CB resembles the bundling requirement for inpatient hospital
geographic variation in wages using the hospital wage index.
services that has been in effect since the early 1980s, assigning to the facility itself
Annual updates: Payment rates are increased each Federal fiscal year using a SNF
the Medicare billing responsibility for virtually the entire package of services that a
market basket index.
facility resident receives, except for certain services that are specifically excluded.
Also enacted in the Balanced Budget Act of 1997 (BBA), Public Law 105-33,
CB eliminates the potential for duplicative billings for the same service to the Part
Section 4432(b), is a Consolidated Billing (CB) requirement for SNFs. Under the CB
A fiscal intermediary by the SNF and the Part B carrier by an outside supplier. It
requirement, an SNF itself must submit all Medicare claims for the services that its
also enhances the SNF’s capacity to meet its existing responsibility to oversee and
residents receive (except for specifically excluded services listed below).
coordinate the total package of care that each of its residents receives.
9
Section III—Coverage, coding and payment for LTV series ventilators
Process for utilizing the LTV series ventilators
Create with your customer, the process for determining that the LTV ventilator is the
best choice for a particular patient:
1.Develop relationships with the physician, case manager, the DME provider and if
possible and of great importance, a caregiver to the patient.
a. Generally, steps 1 and 2 occur concurrently. As the ventilator is being
presented to the physician and /or RT, the relationship/s necessary to be
successful begin. b. Remember to network with the case manager and the patient’s caregiver (this
so time invested in training staff and caregivers on the ventilator will be time
well-spent.
i. If nurses and RTs do not feel comfortable using the ventilator, the
discomfort becomes the reason for its lack of success, not the lack of
familiarity on the part of the staff.
b.Remember, once a patient is discharged on another ventilator, it is a lost
opportunity and one not likely to be regained; therefore, getting to the patient
prior to their discharge from an institutional setting is a critical step. There
are a number of tools available to support the benefits of the LTV ventilator
will be the parent when dealing with a child). These individuals will be strong
and assist in convincing the physician, case manager and caregiver of the LTV
advocates for the LTV ventilator and make powerful arguments to the payer in
ventilator’s capabilities.
favor of the LTV ventilator.
i. Instances exist where payers agreed to pay or provide increased
reimbursement simply because the parent was relentless in their pursuit to
obtain the best product/value for their child.
2.Have the patient placed on the LTV ventilator while in a subacute care/step down
unit to demonstrate the benefits and to have the patient and family acclimate
to the ventilator. Have them “get a feel” for the value of the ventilator and thus
create a strong desire.
3.Now it is time to have all of the parties involved “buy-in” to the LTV ventilator as
the ventilator of choice. The goal is for all parties to recite the ventilator’s benefits
for this particular patient.
a.Success in demonstrating the features and benefits to the patient, caregiver .
and providers will be directly proportional to the amount of time spent
familiarizing them with the ventilator and its capabilities. It can be said that .
10
the LTV ventilator is only as good as the weakest person on the night shift, .
i. These tools include reprints of clinical articles, reference lists, in-service
videos, media kits, etc., but none of these replace the direct interaction with
these influencers.
ii.If these individuals are not convinced that the LTV ventilator is the ventilator
of choice, chances of success in selling the LTV ventilator will be diminished.
4.Once a commitment for the LTV ventilator is obtained, the next step is to
establish medical necessity by having/coaching the physician on the medical
necessity for the prescription and answering any foreseen issues with
reimbursement. The physician needs to write a Certificate of Medical Necessity,
which should include information as outlined on the following page:
a.The patient’s medical history and respiratory ailment.
b.A synopsis of the most recent episode. This is typically the reason why they .
are now in the hospital.
c.Why they need Pressure Support, Pressure Control and Flow Triggering.
Ventilator coding and payment information
d.Describe the alternatives or “consequences” if they don’t receive the benefit/s
Coding:
from the listed feature/s above. These consequences may include:
i. A longer and more costly hospital stay
E0450
ii.A longer weaning time
iii.Risk of a repeated acute episode of a respiratory illness resulting in an
E0461
emergency room visit and possible re-admission into the hospital.
5.Determine the appropriate reimbursement code to be used BEFORE the patient .
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is discharged.
6.Be prepared to answer several questions and overcome any resistance to why the
A9279
patient needs the LTV ventilator.
1. Site of service: Home—the payment process
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Volume Control ventilator, without Pressure Support mode, may include Pressure
Control mode, used with invasive interface (e.g., tracheostomy tube)
Volume Control ventilator, without Pressure Support mode, may include Pressure
Control mode, used with noninvasive interface (e.g., mask)
Pressure Support ventilator with Volume Control mode, may include Pressure
Control mode, used with invasive interface (e.g., tracheostomy tube)
Monitoring feature/device, standalone or integrated, any type, includes all
accessories, components and electronics, not otherwise classified
Pressure Support ventilator with Volume Control mode, may include Pressure
Control mode, used with noninvasive interface (e.g., mask)
Establishing medical necessity
Answer the question, “Why does the patient require a ventilator?” Describe the
medical purpose for ventilatory support, such as respiratory insufficiency/failure .
Payment:
due to [name the disease/s]. Physiologic parameters play a role in medical necessity .
The following information is designed to provide guidance on determining the
(e.g., ABGs demonstrating before and after results from being placed on the
most appropriate code/s to use, provide some guidelines to assist in preparing
ventilator, SpO2 readings, NIF, etc.).
reimbursement submissions and put forth some examples on a state-by-state basis
Ventilator coverage example
Positive and negative pressure ventilators are generally covered for treatment of
neuromuscular diseases, thoracic restrictive diseases and chronic respiratory failure
associated with chronic obstructive pulmonary disease.
whereby submissions have been completed.
• Medicare
- For the most current Medicare fee schedules, please use the HCPCS code
search at: http://www.dmepdac.com.
• Medicaid
- Representative State Medicaid fee schedules can be found on the below
table/s. Every effort was given to achieve accuracy in reporting this information
as of September 2011.
11
Medicaid reimbursement by state
State
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Notes
Alabama
$649.07
$801.64
$1,125.10
Not list
Alaska
$781.48
$1,002.05
$1,408.30
$1,408.30
Arizona
$29.72/day
$29.72/day
$43.79/day
$43.79/day
California
$649.07
$649.07
$1,125.10
$1,125.10
Colorado
$608.08
$774.29
$1,374.39
$1374.39
Florida
$756.60
N/A
$756.60
$756.60
Medical necessity
Georgia
$763.62
Not covered
$1,125.10
$1,125.10
Prior authorization required
Illinois
$855.81
$394.33
$855.81
$855.81
Prior authorization required
Indiana
$770.77
$809.15
$1,135.65
$1,135.65
Kentucky
$913.17
Not covered
$1,265.74
$1,265.74
Manually priced - MSRP -
Manually priced - MSRP -
18% OR provider invoice
18% OR provider invoice
submitted amount
submitted amount
Manually priced - MSRP Louisiana
18% OR provider invoice
Not covered
submitted amount
Maine
$792.25
$791.46
$1,253.94
$1,253.94
$1,002.25 (rental 1st 6 mos)
$1,002.25 (rental 1st 6 mos)
$1,255.19 (rental 1st 6 mos)
$1,255.19 (rental 1st 6 mos)
$851.91 (7 mos & beyond)
$851.91 (7 mos & beyond)
$1,476.70 (7 mos & beyond)
$1,476.70 (7 mos & beyond)
Michigan
$843.04
$708.01
$843.04
Manually priced
Minnesota
$1,001.25
$1,001.25
$1,475.22
$1,475.22
Massachusetts
Prior authorization required
Prior authorization required:
602.417.4400
Prior authorization required
Prior authorization required:
Form 10013
Prior authorization required
Prior authorization required
Out of state providers require prior
authorization
Yes, web-forms
Covered for rental only; they never cap;
prior authorization required if both
stationary and portable are ordered
Mississippi
Missouri
12
$680.85
$825.00 and $412.50 for
backup vent
$680.85
Not covered
$1,180.18
$1,180.18
First vent: $1,406.38
Not an approved code in the
Second vent: $703.19
State of MO
Nebraska
$917.44
$1,087.30
$1,466.93
$1,466.93
Ohio
$760.00
Not covered
$900.00
Not Covered
Pennsylvania
$778.32
$801.64
$1,181.36
Not Covered
South Dakota
$859.84
$1,001.25
$1,475.22
$1,475.22
Prior authorization required
Prior authorization required at http://
www.dss.mo.gov/mhd/cs/dmeprecert/
pages/dmeprecert.htm
Medicaid reimbursement by state (continued)
State
E0450
E0461
E0463
E0464
Notes
Texas
$949.79
Not covered
$949.79
$1,476.70
Prior authorization required
Vermont
$8794.5
Manually priced
Manually priced
Not covered
E0461 requires prior authorization
Virginia
$13,015.34
$13,015.34
$1,284.9
$1,284.9
Washington
$851.91
$851.91
$1,476.7
$1,476.7
E0463/E0464 prior authorization
required; will pay $425.95 for 2nd backup ventilator
Wisconsin
$7,123.03
Not covered
$8,226.45
$8,226.45
Yes, prior authorization required after
60 days w/ E0450
Frequently asked questions
Time and Variable Termination Criteria. (The other is the TBird Legacy. .
Why does the LTV ventilator cost more than a conventional ventilator?
The I-Vent offers Variable Rise Time, but does not offer Variable .
• The LTV ventilator employs the latest technology in a form and function that
results in higher manufacturing cost.
• There was also a substantial investment in developing this technology and the
benefits derived from this equipment are three-fold:
- It can assist in reducing the overall cost of caring for the patient since they can
be discharged sooner than previously possible.
- Depending on the patient’s condition, the LTV ventilator’s features .
(e.g., Pressure Support) may reduce the time to wean a patient from a
ventilator, resulting in an overall reduction in costs.
- The LTV ventilator’s size and weight has been said to increase a patient’s quality
of life since the patient and their family members are more mobile.
Which ventilator gets prescribed for what medical necessity?
• If the medical necessity is for Pressure Support: Termination Criteria).
- All of these ventilators are priced in the same range. The PLV and LP series
ventilators do not offer Pressure Support.
• If the medical necessity is for Pressure Control and Pressure Support: - The LTV 950 and 1150 ventilators offer Pressure Control and Pressure Support
with Variable Rise Time and Variable Termination Criteria.
- The T Bird Legacy does not offer Pressure Control and the Achieva does not
offer Pressure Control with Pressure Support (SIMV).
- The I-Vent offers Pressure Support with Pressure Control, but does not provide
Variable Termination Criteria.
- All of these ventilators are priced competitively among each other.
- The PLV and LP series ventilators do not offer Pressure Control or .
Pressure Support.
- The LTV ventilator is currently one of two commercially available ventilators with
510(k) clearance for the home that offers Pressure Support with Variable Rise
13
• If the medical necessity is for Flow Triggering:
Claims for upgrades
- All of the LTV ventilators offer flow triggering, except the LTV 800.
Two lines should be listed on each claim for an upgrade. Suppliers will need
- The T-Bird Legacy and I-Vent also offer flow triggering.
to bill their submitted charges for the upgraded item on Line 1 and the full
- The Achieva only offers flow triggering when attached to a high-pressure
external gas source, which is typically not found in the home.
- The PLV and LP series ventilators do not offer flow triggering.
What if the physician order is for a Volume ventilator (E0450 or E0461)
and all the HME provider has in stock or carries in inventory are
Pressure Support (E0463 or E0464) ventilators?
amount for the physician order on Line 2. Both line items are to appear on a
single claim.
Claims for free upgrades
When providing a free upgrade to a beneficiary, suppliers should report the
appropriate HCPCS code for the non-upgraded item that the physician ordered.
A “GL” modifier is attached to the HCPCS code for the physician-ordered item
to indicate it is an upgraded item at no additional charge. Suppliers may only
• Bill using the upgrade provision with appropriate modifiers. charge for the non-upgraded item on the claim form. In this situation, the
• Payment will be granted for the reasonable and necessary therapy/Volume
supplier does not bill the HCPCS code that describes the item being provided.
ventilator (E0450 or E0461) that the physician prescribed.
• In addition, be certain to escalate some example claims through your MAC’s
In box 19 of the claim form, or as an attachment to the claim, the supplier
must specify the make and model of the upgraded item that was provided
customer service process, as this will identify the need for any code and/or
and describe why this item is an upgrade. If filing claims electronically,
fee schedule rate change/s necessary
this information may be entered in the NTE segment/line note on the 837
Background
electronic format.
Suppliers may use advanced beneficiary notices (ABNs) when providing
upgrades. CMS defines an upgrade as an item that is more expensive because
the item contains more components or features, or is greater in quantity than
what the physician ordered. Items that are simply more expensive, or of “higher
quality” than standard items, do not qualify as an upgrade.
DME upgrades
ABN and claims modifiers
Upgrades must be within the range of services that are appropriate for the
beneficiary’s medical condition. ABNs may not be used to substitute an item or
ABN
required
Required
modifier/s
DMAC
payment
Beneficiary
pays for
upgrade
No
GL
R&N item
only (GL
line)
No
service that does not meet the intended medical purpose of the item originally
ordered by the physician.
An ABN is not required if the supplier chooses to provide a free upgrade to
the beneficiary. When providing a free upgrade, suppliers should not have the
beneficiary sign an ABN, because the beneficiary will not be charged more than .
the normal deductible and copayment for the non-upgraded item.
3. Supplier provides
upgrade for supplier
convenience:
a. Supplier provides
upgrade free
of charge to
beneficiary
GL is added to HCPCS code for item that meets Medicare coverage requirements and demonstrated
that this is an upgraded item at no additional charge.
14
R&N = Reasonable and necessary
2. Site of service: LTAC—the payment process
• Beginning in FY 2008, CMS adopted the refined severity-adjusted DRGs
that were also adopted under the IPPS, that is, the Medicare-Severity-LTC-
LTAC fixed per diem rate is the daily rate Medical Assistance Administration
DRGs (MS-LTC-DRGs), which continue to be weighted to account for the
(MAA) reimburses for LTAC room and board and selected services. Refer to
difference in resource use by LTAC patients.
prior authorization information for more details about selected services.
Payment rate
• Payments to LTACs under the LTAC PPS is based on a single standard Federal
3. Site of service: SNF—the payment process
Resource Utilization Group (RUG): A ventilator patient example
rate for both the inpatient operating and capital-related costs, but not
The case-mix adjusted rates for each of the RUG groups can be found in the
certain pass-through costs.
final rule for the SNF PPS. They are:
• The LTAC payment is determined by CMS starting with the standard Federal
rate, which is the standard Federal rate for the previous LTAC PPS rate
year, updated by the increase factor, and adjusted for outlier payments and
budget neutrality. • The standard Federal rate is multiplied by the applicable Medicare severity
• SE3: $374 (urban); $364 (rural)
• SE2: $318 (urban); $310 (rural)
• SE1: $283 (urban); $277 (rural)
These do not include the AIDS adjustment or the geographic adjustment. The
for long-term care diagnostic related group (MS-LTC-DRG) relative weight to
labor portion of the rule is then adjusted for geographic variation using the
determine the Federal prospective payment that is paid for each discharge.
hospital wage index. Those rates are in the final rule. - Referred to as the unadjusted LTCH-PPS payment.
- This amount is then subject to the case-level adjustments and facility-level
adjustments for each discharge.
• Under the LTAC PPS, patients are classified into distinct diagnostic groups
based on clinical characteristics and expected resource needs. The patient
classification system groupings under the LTAC PPS are called long-term care
diagnosis-related groups (LTC-DRGs).
- The LTC-DRGs are the same DRGs used under the hospital inpatient
prospective payment system (IPPS), but they have been weighted to reflect
the resources required to treat the type of medically complex patients’
characteristic of LTACs.
- Relative weights for the LTC-DRGs reflect resource utilization for each
diagnosis and account for the variation in cost per discharge.
•Under the LTAC PPS, the LTC-DRG relative weights are updated annually for
each Federal fiscal year (October 1 through September 30) using the most
recently available LTAC claims data. Long-term acute care ventilator facility EXAMPLE
LTC – DRG
207
Title
Resp system diagnosis w/ vent support 96+ hours
Relative weight
2.1381
Average length of stay
34.6
Threshold: Short stay outlier
28.8
LTAC cases
13,299
LTCH-PPS payment
$79,268
Note:
•The “unadjusted LTCH-PPS payment” is $79,268.
•This calculation was derived by multiplying the FY2009 standard Federal rate times the
FY2008 relative weight: $39,114 x 2.0266 for this example.
•Numbers were extrapolated from Table 3 in the May 9, 2008 LTCH-PPS final rule.
15
Category:
Moving on to Medicaid: A ventilator patient example
Extensive services: Services that last 14 days: IV feeding or medications, suctioning,
Post 100 days of the patient receiving Part A Medicare benefits, coverage .
tracheostomy care, ventilator / respirator. (If MDS meets this criteria, but ADL < 7,
stops unless another SNF event is identified. Ventilator patients who stay on .
then the MDS automatically classifies under Special Care.*) go to Medicaid services and are now considered non-covered by Medicare .
ADL = 7 - 18 and are outpatients.
End splits: Extensive services count: IV feedings, IV medications, special care,
Medicaid payments vary from state-to-state. For example, PA and TN pay a bundled
clinically complex, impaired cognition
RUG category: SE3, SE2, SE1
PPS/RUG format, so ventilator payment continues to be part of that bundle. The
SNF bills and the HME provider rents to the SNF as during the Medicare stay. Some
states use the DME HCPCS fee schedule payment for ventilators. Remember, in
order to bill Level II HCPCS, a supplier number is required.
16
Section IV—Coding verification competitive products
Coding verification for Pressure Support ventilators
Manufacturer
Product name
™
*HCPCS code/s
LTV 900 ventilator
LTV 950 ventilator
LTV 1000 ventilator
TBird® Legacy
E0463 (invasive) or E0464 (noninvasive)
CareFusion (also under the name of Pulmonetic Systems, Inc.
and Viasys Healthcare Respiratory Technologies Group)
ReVel ventilator
LTV 1200 ventilator
LTV 1150 ventilator
LTV 1100 ventilator
Covidien (also under the name of Nellcor Puritan Bennett—
a Tyco Healthcare Company)
Puritan Bennett 540
Achieva PS
Achieva PSO2
E0463 or E0464
E0463
E0463
GE Healthcare (also under the name of Versamed, Inc.)
IVent
IVent
IVent
IVent
IVent
E0463 or E0464
E0463 or E0464
E0463 or E0464
E0463
E0463
Newport Medical Instruments
Newport
Newport
Newport
Newport
Philips Respironics
Trilogy 200 ventilator
Trilogy 100 ventilator
PLV continuum ventilator
E0463+, A9279 or E0464+
E0463 or E0464
E0463 or E0464
CareFusion
LTV 800 laptop ventilator
E0450 (invasive) or E0461 (noninvasive)
Covidien
LP10 volume ventilator
E0450
Philips/Respironics
LifeCare PLV-100
portable volume ventilator
E0450
101 expert model
101 performance model
101 signature model
201-IC
201-IC/AB
HT70 family of ventilators
HT70M family of ventilators
HT50-H ventilator
HT50-H1 ventilator
E0463 (invasive) or E0464 (noninvasive)
*Codes *Descriptors
E0450
Volume Control ventilator, without Pressure Support mode, may include Pressure Control mode, used with invasive interface (e.g., tracheostomy tube)
E0461
Volume Control ventilator, without Pressure Support mode, may include Pressure Control mode, used with noninvasive interface (e.g., mask)
E0463
Pressure Support ventilator with Volume Control mode, may include Pressure Control mode, used with invasive interface (e.g., tracheostomy tube)
A9279
Monitoring feature/device, standalone or integrated, any type, includes all accessories, components and electronics, not otherwise classified
E0464
Pressure Support ventilator with Volume Control mode, may include Pressure Control mode, used with noninvasive interface (e.g., mask)
17
Section V—Accessory coding and payment
How are accessories to ventilators coded and paid?
The ventilator codes we have been discussing address positive and negative pressure ventilators used with invasive or noninvasive interfaces. Medicare categorizes ventilators
as items requiring frequent and substantial servicing. For items that fall in the payment category of frequent and substantial service, rental payments include payment for
supplies and accessories unless specifically noted otherwise. Humidifiers are considered accessories and cannot be billed separately. Additional payment is not made for
repair, maintenance or replacement of equipment that requires frequent and substantial service. It is the supplier’s responsibility to make certain there is an emergency plan
in place to address mechanical failure of the equipment.
Accessories to ventilators may consist of the following items:
• Humidifiers
• Filters
• Batteries, battery cables, battery charger
• Breathing circuits
Other:
• LTM (Lap Top Monitor graphics package) is coded under A9279 - Monitoring feature/device, standalone or integrated, any type, includes all
accessories, components and electronics, not otherwise classified
18
Glossary of Medicare terms
(CMS) Centers for Medicare and Medicaid Services: The federal agency that runs
the Medicare program. In addition, CMS works with the States to run the Medicaid
program. CMS works to make sure the beneficiaries in these programs are able to get
high quality healthcare.
• “Part A” covers the Medicare inpatient hospital, post-hospital skilled nursing facility care,
home health services and hospice care.
• “Part B” is the supplementary medical insurance benefit (SMIB) covering the Medicare
doctor’s services, outpatient hospital care, outpatient physical therapy and speech
(DRG) Diagnosis Related Group: A classification system that categorizes hospital
pathology services, home healthcare and other health services and supplies not covered
patients into clinically coherent and homogenous groups with respect to resource use
under Part A of Medicare.
(i.e., similar treatments and statistically similar lengths of stay for patients with related
medical conditions). Classification of patients is based on the International Classification
of Diseases, the presence of a surgical procedure, patient age, presence or absence of
significant co-morbidities or complications and other relevant criteria.
Medically necessary: A term for describing [a] requested service that is reasonably
calculated to prevent, diagnose, correct, cure, alleviate or prevent worsening of conditions
in the client that endanger life, or cause suffering or pain, or result in an illness or infirmity,
or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction.
(HCPCS) Healthcare Common Procedural Coding System: A medical code set that
There is no other equally effective, more conservative or substantially less costly course of
identifies healthcare procedures, equipment and supplies for claim submission purposes. .
treatment available or suitable for the client requesting the service. For some purposes,
It has been selected for use in the HIPAA transactions. HCPCS Level I contain numeric .
“course of treatment” may include mere observation or, where appropriate, no treatment
CPT codes, which are maintained by the AMA. HCPCS Level II contains alphanumeric
at all.
codes used to identify various items and services that are not included in the CPT medical
code set.
(LTAC) Long term acute care: Inpatient intensive long-term acute care services provided
in MAA-approved LTAC facilities to eligible Medical Assistance clients who require Level .
1 or Level 2 services.
LTAC fixed per diem rate: The daily rate MAA reimburses for LTAC room and board
and selected services.
Non-covered service or charge: A service or charge that is not covered by the Medical
Assistance Administration, including, but not limited to, such services or charges as a
private room, circumcision and video recording of the procedure.
Pricing, data analysis and coding (PDAC): Provides support to the DME Program
Safeguard Contractors (PSCs) along with guiding manufacturers and suppliers on the
proper use of HCPCS.
Ratio of costs-to-charges (RCC): The methodology used to pay hospitals for services
Market basket: Described as a fixed-weight index because it answers the question of
exempt from the DRG payment method. It also refers to the factor applied to a hospital’s
how much more or less it would cost, at a later time, to purchase the same mix of goods
allowed charges for medically necessary services to determine payment to the hospital for
and services that was purchased in a base period. As such, it measures “pure” price
these DRG-exempt services.
changes only. A market basket is constructed in three steps. The sum of the products for
all cost categories yields the composite index level in the market basket in a given year.
Reasonable cost: Fiscal Intermediaries and carriers use CMS guidelines to determine
reasonable costs incurred by individual providers in furnishing covered services to enrollees.
Medicaid: The state and federally funded Title XIX program under which medical care is
Reasonable cost is based on the actual cost of providing such services, including direct
provided to persons eligible for the categorically needy program or medically needy program.
and indirect cost of providers and excluding any costs that are unnecessary in the efficient
Medicare: The federal government health insurance program for certain aged
delivery of services covered by the program.
or disabled clients under Titles II and XVIII of the Social Security Act. Medicare .
has two parts:
19
Abbreviations and acronyms
ABN—Advance Beneficiary Notice
ICF—Intermediate Care Facility
ADMC—Advance Determination of Medicare Coverage
ICN—Internal Claim Number
ALJ—Administrative Law Judge
ICU—Intensive Care Unit
BBA—Balanced Budget Act
IRP—Inexpensive or Routinely Purchased
CMN—Certificate of Medical Necessity
LMRP—Local Medical Review Policies
CMR—Comprehensive Medical Review
MAA—Medical Assistance Administration
CMS—Centers for Medicare and Medicaid Services
MCM—Medicare Carriers Manual
COB—Coordination of Benefit
MedPAC—Medicare Payment Advisory Commission
COPD—Chronic Obstructive Pulmonary Disease
MSN—Medicare Summary Notice
CWF—Common Working File
MSP—Medicare Secondary Payer
DHHS—Department of Health and Human Services
NF—Nursing Facility
DME—Durable Medical Equipment
NH—Nursing Home
DMEPOS—Durable Medical Equipment, Prosthetics, Orthotics and Supplies
NON-PAR—Non-Participating Provider
DRG—Diagnosis Related Groups
NOS—Not Otherwise Specified
DX—Diagnosis
NSC—National Supplier Clearinghouse
ECF—Extended Care Facility
NSF—National Standard Format
EOMB—Explanation of Medicare Benefits
OBRA—Omnibus Budget Reconciliation Act
ERN—Electronic Remittance Notice
OIG—Office of the Inspector General
FDA—Food and Drug Administration
OPPS—Outpatient Prospective Payment System
HCPCS—Healthcare Common Procedure Coding System
PA—Prior Authorization
HHA—Home Health Agency
PAR—Participating Provider
HHS—Health and Human Services
PIN—Provider Identification Number
HICN—Health Insurance Claim Number
RA—Remittance Advice
HIPAA—Health Insurance Portability and Accountability Act
Rx—Prescription
HMO—Health Maintenance organization
PDAC—Statistical Analysis Durable Medical Equipment Regional Carrier
ICD-9-CM—International Classification of Diseases,
SNF—Skilled Nursing Facility
Clinical Modification, 9th Revision
20
UPIN—Unique Provider Identification Number
Helpful Reimbursement Websites
Region A MAC: National Heritage
Approved Accreditation Agency Contact List
http://www.medicarenhic.com/dme/index.shtml
http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/
Region B MAC: AdminaStar Federal
Competitive Bidding Implementation Contractor (CBIC)
http://www.ngsmedicare.com/ngsmedicare/HomePage.aspx
http://www.dmecompetitivebid.com/palmetto/cbic.nsf/DocsCat/Home
Region C MAC: Cigna Medicare
DMEPOS competitive bidding overview
http://www.cignagovernmentservices.com/jc/index.html
http://www.cms.hhs.gov/DMEPOSCompetitiveBid/
Region D MAC: Noridian Administrative Services
Durable Medical Equipment Code System (DMECS)
https://www.noridianmedicare.com/dme/index.html
https://www.dmepdac.com/
CMS Durable Medical Equipment Center
DMEPOS fee schedule
http://www.cms.hhs.gov/center/dme.asp
http://www.cms.hhs.gov/DMEPOSFeeSched/LSDMEPOSFEE/list.asp#TopOfPage
State Medicaid webpage links
http://64.82.65.67/medicaid/states.html
DMEPOS Quality Standards
http://www.cms.hhs.gov/CompetitiveAcqforDMEPOS/04_New_Quality_
Standards.asp
21
WARNING—U.S. Federal Law restricts this device to sale by or on the order of a physician.
CareFusion
22745 Savi Ranch Parkway
Yorba Linda, CA 92887
800.231.2466 toll-free
714.283.2228 tel
714.283.8493 fax
CareFusion Germany 234 GmbH
Leibnizstrasse 7
97204 Hoechberg
Germany
+49 931 4972-0 tel
+49 931 4972-423 fax
CareFusion
Yorba linda, CA
carefusion.com
© 2011 CareFusion Corporation or one of its subsidiaries. All rights reserved. LTV is a trademark or registered trademark of CareFusion
Corporation or one of its subsidiaries. All other trademarks are property of their respective owners. RC2834 (1111/2500) L3431 Rev. A