04/28/2023

DME MACs Publish Guidance on Claim Submission Instruction for Post-PHE

 

The following article was published today as a Joint DME MAC publication.

 

Claim Submission Instruction Post-PHE – Continued Use of Modifier CR and COVID Narrative

After the end of the Public Health Emergency on May 11, 2023, suppliers will require a method for indicating that claims for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items were specifically excluded from enforcement of the clinical indications of coverage referenced in Interim Final Rules CMS-1744-IFC and CMS-5531-IFC. The National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) impacted by these interim rules are:

• Home Oxygen (NCD 240.2)
• Infusion Pumps (NCD 280.14)
• Continuous Positive Airway Pressure for Obstructive Sleep Apnea (NCD 240.4)
• Intrapulmonary Percussive Ventilator (NCD 240.5)
• Durable Medical Equipment Reference List (NCD 280.1) – Only clinical indications for ventilators are not enforced
• Oxygen and Oxygen Equipment (L33797)
• Positive Airway Pressure Devices for the Treatment of Obstructive Sleep Apnea (L33718)
• Oral Appliances for the Treatment of Obstructive Sleep Apnea (L33611)
• Respiratory Assist Devices (L33800)
• Mechanical In-exsufflation Devices (L33795)
• High Frequency Chest Wall Oscillation (L33785)
• Nebulizers (L33370)
• Suction Pumps (L33612) – Only clinical indications for respiratory suction pumps (E0600) are not enforced
• Glucose Monitors (L33822) – Only clinical indications for Continuous Glucose Monitors (CGM) are not enforced
• External Infusion Pumps (L33794)

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