PainTechnology Medicare Face Notice Bulletin Number User Manual

User Manual: PainTechnology Medicare Face Notice

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Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to

statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of

either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and

accurate statement of their contents. CPT only copyright 2012 American Medical Association.

Page 1 of 11

DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services Centers for Medicare & Medicaid Services

REVISED products from the Medicare Learning Network® (MLN)

• “The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Competitive Bidding Program: Traveling Beneficiary,” Fact Sheet, ICN 904484,

Downloadable only.

MLN Matters® Number: MM8304 Related Change Request (CR) #: CR 8304

Related CR Release Date: May 31, 2013 Effective Date: July 1, 2013

Related CR Transmittal #: R468PI Implementation Date: July 1, 2013

Detailed Written Orders and Face-to-Face Encounters

Provider Types Affected

This MLN Matters® Article is intended for physicians, Physician Assistants (PAs), Nurse Practitioners

(NPs), Clinical Nurse Specialists (CNSs) and suppliers submitting claims to Durable Medical

Equipment Medicare Administrative Contractors (DME MACs) for certain Durable Medical Equipment

(DME) items and services provided to Medicare beneficiaries.

What You Need to Know

This article is based on Change Request (CR) 8304, which instructs DME MACs to implement

requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters

conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g).

(That section is available at http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol2/pdf/CFR-2011-

title42-vol2-sec410-38.pdf on the Internet.) When a claim for these items is selected for review,

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 2 of 11

contractors must deny the claim if the requirements for a face-to-face encounter are not met.

Make

sure that your billing staffs are aware of these requirements.

Background

As a condition for payment, Section 6407 of the Affordable Care Act requires a physician to document

that the physician, PA, NP or CNS has had a face-to-face encounter examination with a beneficiary in

the six (6) months prior to the written order for certain items of DME (the complete list of items is found

in Appendix A at the end of this article). This section does not apply to Power Mobility Devices (PMDs)

as these items are covered under a separate requirement.

This includes encounters conducted via the Centers for Medicare & Medicaid Services (CMS)-

approved use of telehealth (as described in Chapter 15 of the "Medicare Benefit Policy Manual" and

Chapter 12 of the "Medicare Claims Processing Manual"). Those manuals are available at

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html on

the CMS website.

Note that the date of the written order must not be prior to the date of the face-to-face encounter.

The face-to-face encounter conducted by the physician, PA, NP, or CNS must document that the

beneficiary was evaluated and/or treated for a condition that supports the item(s) of DME ordered.

In the case of a DME ordered by a PA, NP, or CNS, a physician (MD or DO) must document the

occurrence of a face-to-face encounter by signing/co-signing and dating the pertinent portion of the

medical record.

The written order for the DME must include, at a minimum;

1. the beneficiary's name,

2. the item of DME ordered,

3. the prescribing practitioner's National Provider Identifier (NPI),

4. the signature of the ordering practitioner and

5. the date of the order.

Failure to meet any of the above requirements will result in denial of the claim.

Physicians will be provided an additional payment, using code G0454, for signing/co-signing the face-

to-face encounter of the PA/NP/CNS. The physician should not bill the G code when he/she conducts

the face-to-face encounter. Note that the G code may only be paid to the physician one time per

beneficiary per encounter, regardless of the number of covered items documented in the face-to-face

encounter.

CR8304 implements these changes in Chapter 5 of the "Program Integrity Manual" to support 42

Code of Federal Regulations (CFR) 410.38(g) and the revised portion of that manual is attached to

CR8304.

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Page 3 of 11

Additional Information

The official instruction, CR8304, issued to your DME MAC regarding this change, may be viewed at

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R468PI.pdf

on the CMS website.

If you have any questions, please contact your DME MAC at their toll-free number, which may be

found at http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-

Programs/provider-compliance-interactive-map/index.html on the CMS website.

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 4 of 11

Appendix A

The DME list of Specified Covered Items are as follows, the original list was at 77 FR 44798:

HCPCS

Code Description

E0185 Gel or gel-like pressure mattress pad

E0188 Synthetic sheepskin pad

E0189 Lamb's wool sheepskin pad

E0194 Air fluidized bed

E0197 Air pressure pad for mattress standard length and width

E0198 Water pressure pad for mattress standard length and width

E0199 Dry pressure pad for mattress standard length and width

E0250 Hospital bed fixed height with any type of side rails, mattress

E0251 Hospital bed fixed height with any type side rails without mattress

E0255 Hospital bed variable height with any type side rails with mattress

E0256 Hospital bed variable height with any type side rails without mattress

E0260 Hospital bed semi-electric (Head and foot adjustment) with any type side

rails with mattress

E0261 Hospital bed semi-electric (head and foot adjustment) with any type side rails

without mattress

E0265 Hospital bed total electric (head, foot and height adjustments) with any type

side rails with mattress

E0266 Hospital bed total electric (head, foot and height adjustments) with any type

side rails without mattress

E0290 Hospital bed fixed height without rails with mattress

E0291 Hospital bed fixed height without rail without mattress

E0292 Hospital bed variable height without rail without mattress

E0293 Hospital bed variable height without rail with mattress

E0294 Hospital bed semi-electric (head and foot adjustment) without rail with

mattress

E0295 Hospital bed semi-electric (head and foot adjustment) without rail without

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 5 of 11

HCPCS

Code Description

mattress

E0296 Hospital bed total electric (head, foot and height adjustments) without rail

with mattress

E0297 Hospital bed total electric (head, foot and height adjustments) without rail

without mattress

E0300 Pediatric crib, hospital grade, fully enclosed

E0301 Hospital bed Heavy Duty extra wide, with weight capacity 350-600 lbs with

any type of rail, without mattress

E0302 Hospital bed Heavy Duty extra wide, with weight capacity greater than 600

lbs with any type of rail, without mattress

E0303 Hospital bed Heavy Duty extra wide, with weight capacity 350-600 lbs with

any type of rail, with mattress

E0304 Hospital bed Heavy Duty extra wide, with weight capacity greater than 600

lbs with any type of rail, with mattress

E0424 Stationary compressed gas Oxygen System rental; includes contents,

regulator, nebulizer, cannula or mask and tubing

E0431 Portable gaseous oxygen system rental includes portable container,

regulator, flowmeter, humidifier, cannula or mask, and tubing

E0433 Portable liquid oxygen system

E0434

Portable liquid oxygen system, rental; includes portable container, supply

reservoir, humidifier, flowmeter, refill adaptor, content gauge, cannula or

mask, and tubing

E0439 Stationary liquid oxygen system rental, includes container, contents,

regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing

E0441 Oxygen contents, gaseous (1 months supply)

E0442 Oxygen contents, liquid (1 months supply)

E0443 Portable Oxygen contents, gas (1 months supply)

E0444 Portable oxygen contents, liquid (1 months supply)

E0450 Volume control ventilator without pressure support used with invasive

interface

E0457 Chest shell

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 6 of 11

HCPCS

Code Description

E0459 Chest wrap

E0460 Negative pressure ventilator portable or stationary

E0461 Volume control ventilator without pressure support node for a noninvasive

interface

E0462 Rocking bed with or without side rail

E0463 Pressure support ventilator with volume control mode used for invasive

surfaces

E0464 Pressure support vent with volume control mode used for noninvasive

surfaces

E0470 Respiratory Assist Device, bi-level pressure capability, without backup rate

used non-invasive interface

E0471 Respiratory Assist Device, bi-level pressure capability, with backup rate for

a non-invasive interface

E0472 Respiratory Assist Device, bi-level pressure capability, with backup rate for

invasive interface

E0480 Percussor electric/pneumatic home model

E0482 Cough stimulating device, alternating positive and negative airway pressure

E0483 High Frequency chest wall oscillation air pulse generator system

E0484 Oscillatory positive expiratory device, non-electric

E0570 Nebulizer with compressor

E0575 Nebulizer, ultrasonic, large volume

E0580 Nebulizer, durable, glass or autoclavable plastic, bottle type for use with

regulator or flowmeter

E0585 Nebulizer with compressor & heater

E0601 Continuous airway pressure device

E0607 Home blood glucose monitor

E0627 Seat lift mechanism incorporated lift-chair

E0628 Separate Seat lift mechanism for patient owned furniture electric

E0629 Separate seat lift mechanism for patient owned furniture non-electric

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 7 of 11

HCPCS

Code Description

E0636 Multi positional patient support system, with integrated lift, patient accessible

controls

E0650 Pneumatic compressor non-segmental home model

E0651 Pneumatic compressor segmental home model without calibrated gradient

pressure

E0652 Pneumatic compressor segmental home model with calibrated gradient

pressure

E0655 Non- segmental pneumatic appliance for use with pneumatic compressor on

half arm

E0656 Non- segmental pneumatic appliance for use with pneumatic compressor on

trunk

E0657 Non- segmental pneumatic appliance for use with pneumatic compressor

chest

E0660 Non- segmental pneumatic appliance for use with pneumatic compressor on

full leg

E0665 Non- segmental pneumatic appliance for use with pneumatic compressor on

full arm

E0666 Non- segmental pneumatic appliance for use with pneumatic compressor on

half leg

E0667 Segmental pneumatic appliance for use with pneumatic compressor on full-

leg

E0668 Segmental pneumatic appliance for use with pneumatic compressor on full

arm

E0669 Segmental pneumatic appliance for use with pneumatic compressor on half

leg

E0671 Segmental gradient pressure pneumatic appliance full leg

E0672 Segmental gradient pressure pneumatic appliance full arm

E0673 Segmental gradient pressure pneumatic appliance half leg

E0675 Pneumatic compression device, high pressure, rapid inflation/deflation cycle,

for arterial insufficiency

E0692 Ultraviolet light therapy system panel treatment 4 foot panel

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 8 of 11

HCPCS

Code Description

E0693 Ultraviolet light therapy system panel treatment 6 foot panel

E0694 Ultraviolet multidirectional light therapy system in 6 foot cabinet

E0720 Transcutaneous electrical nerve stimulation, two lead, local stimulation

E0730 Transcutaneous electrical nerve stimulation, four or more leads, for multiple

nerve stimulation

E0731 Form fitting conductive garment for delivery of TENS or NMES

E0740 Incontinence treatment system, Pelvic floor stimulator, monitor, sensor,

and/or trainer

E0744 Neuromuscular stimulator for scoliosis

E0745 Neuromuscular stimulator electric shock unit

E0747 Osteogenesis stimulator, electrical, non-invasive, other than spine

application.

E0748 Osteogenesis stimulator, electrical, non-invasive, spinal application

E0749 Osteogenesis stimulator, electrical, surgically implanted

E0760 Osteogenesis stimulator, low intensity ultrasound, non-invasive

E0762 Transcutaneous electrical joint stimulation system including all accessories

E0764 Functional neuromuscular stimulator, transcutaneous stimulations of

muscles of ambulation with computer controls

E0765 FDA approved nerve stimulator for treatment of nausea & vomiting

E0782 Infusion pumps, implantable, Non-programmable

E0783 Infusion pump, implantable, Programmable

E0784 External ambulatory infusion pump

E0786 Implantable programmable infusion pump, replacement

E0840 Tract frame attach to headboard, cervical traction

E0849 Traction equipment cervical, free-standing stand/frame, pneumatic, applying

traction force to other than mandible

E0850 Traction stand, free standing, cervical traction

E0855 Cervical traction equipment not requiring additional stand or frame

E0856 Cervical traction device, cervical collar with inflatable air bladder

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 9 of 11

HCPCS

Code Description

E0958 Manual wheelchair accessory, one-arm drive attachment

E0959 Manual wheelchair accessory-adapter for Amputee

E0960 Manual wheelchair accessory, shoulder harness/strap

E0961 Manual wheelchair accessory wheel lock brake extension handle

E0966 Manual wheelchair accessory, headrest extension

E0967 Manual wheelchair accessory, hand rim with projections

E0968 Commode seat, wheelchair

E0969 Narrowing device wheelchair

E0971 Manual wheelchair accessory anti-tipping device

E0973 Manual wheelchair accessory, adjustable height, detachable armrest

E0974 Manual wheelchair accessory anti-rollback device

E0978 Manual wheelchair accessory positioning belt/safety belt/ pelvic strap

E0980 Manual wheelchair accessory safety vest

E0981 Manual wheelchair accessory Seat upholstery, replacement only

E0982 Manual wheelchair accessory, back upholstery, replacement only

E0983 Manual wheelchair accessory power add on to convert manual wheelchair to

motorized wheelchair, joystick control

E0984 Manual wheelchair accessory power add on to convert manual wheelchair to

motorized wheelchair, Tiller control

E0985 Wheelchair accessory, seat lift mechanism

E0986 Manual wheelchair accessory, push activated power assist

E0990 Manual wheelchair accessory, elevating leg rest

E0992 Manual wheelchair accessory, elevating leg rest solid seat insert

E0994 Arm rest

E1014 Reclining back, addition to pediatric size wheelchair

E1015 Shock absorber for manual wheelchair

E1020 Residual limb support system for wheelchair

E1028 Wheelchair accessory, manual swing away, retractable or removable

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 10 of 11

HCPCS

Code Description

mounting hardware for joystick, other control interface or positioning

accessory

E1029 Wheelchair accessory, ventilator tray

E1030 Wheelchair accessory, ventilator tray, gimbaled

E1031 Rollabout chair, any and all types with castors 5" or greater

E1035 Multi-positional patient transfer system with integrated seat operated by care

giver

E1036 Patient transfer system

E1037 Transport chair, pediatric size

E1038 Transport chair, adult size up to 300lb

E1039 Transport chair, adult size heavy duty >300lb

E1161 Manual Adult size wheelchair includes tilt in space

E1227 Special height arm for wheelchair

E1228 Special back height for wheelchair

E1232 Wheelchair, pediatric size, tilt-in-space, folding, adjustable with seating

system

E1233 Wheelchair, pediatric size, tilt-in-space, folding, adjustable without seating

system

E1234 Wheelchair, pediatric size, tilt-in-space, folding, adjustable without seating

system

E1235 Wheelchair, pediatric size, rigid, adjustable, with seating system

E1236 Wheelchair, pediatric size, folding, adjustable, with seating system

E1237 Wheelchair, pediatric size, rigid, adjustable, without seating system

E1238 Wheelchair, pediatric size, folding, adjustable, without seating system

E1296 Special sized wheelchair seat height

E1297 Special sized wheelchair seat depth by upholstery

E1298 Special sized wheelchair seat depth and/or width by construction

E1310 Whirlpool non-portable

E2502 Speech Generating Devices prerecord messages between 8 and 20 Minutes

MLN Matters® Number: MM8304 Related Change Request Number: 8304

Disclaimer

This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes,

regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law

or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

CPT only copyright 2012 American Medical Association.

Page 11 of 11

HCPCS

Code Description

E2506 Speech Generating Devices prerecord messages over 40 minutes

E2508 Speech Generating Devices message through spelling, manual type

E2510 Speech Generating Devices synthesized with multiple message methods

E2227 Rigid pediatric wheelchair adjustable

K0001 Standard wheelchair

K0002 Standard hemi (low seat) wheelchair

K0003 Lightweight wheelchair

K0004 High strength ltwt wheelchair

K0005 Ultra Lightweight wheelchair

K0006 Heavy duty wheelchair

K0007 Extra heavy duty wheelchair

K0009 Other manual wheelchair/base

K0606 AED garment with electronic analysis

K0730 Controlled dose inhalation drug delivery system