Medical Supplies Billing Codes, Units And Quantity Limites .
Medical Supplies Billing Codes, Units and Quantity Limits (mc sup billing)Medical Supplies Billing Codes, Units and Quantity LimitsThis spreadsheet contains medical supply billing codes, unit of measure (UOM) and quantity limits. Refer to the Medical Supplies section of the provider manual for additional information and program coverage. Refer to the appropriate spreadsheet for billing codes restricted tocontracted products. Certain medical supplies must be billed by a pharmacy provider only using the product's 11-digit billing number (NDC). The NDC billed must be an exact match for the product dispensed. This List is subject to change with notification in the provider bulletins.Updates or additions to the spreadsheet will be noted in the “Description of Change" column. Deletions will be on the tab labeled "Medical Supplies Deletions." 'MAPC' refers to the maximum allowable product cost reimbursed.Billing Code(HCPCS)CategoryRestricted toDescriptionMAPC per UnitContractedof MeasureProducts (Y/N)(UOM)NoSyringe with needle, sterile, 1 milliliters or less, By nge with needle, sterile 2 millilitersBy ReporteachNo200 per 27-day periodNoneA4208Syringe/NeedleNoSyringe with needle, sterile 3 millilitersBy ReporteachNo200 per 27-day periodNoneA4209Syringe/NeedleNoBy ReporteachNo200 per 27-day periodNoneA4212Syringe/NeedleNoSyringe with needle, sterile 5 milliliters orgreaterNon-coring needleBy ReporteachNo6 per 27-day periodNoneBy ReporteachNoone per 365-day periodNoneRefer to the Listof Covered SterileNeedles(Excluding PenNeedles)eachNo100 per 27-day periodEffective for dates of service on orafter January 1, 2021, pen needles areno longer billed using HCPCS A4215.Pen needles are pharmacy providerbilling only, subject to a product list,using the product NDC on a pharmacyclaim effective for dates of service onor after January 1, 2021.Syringe, bulb type (infant nasal aspiraters, earand ulcer bulb syringes)Needle, sterile, any size, eachUOMeachTARQuantity Limits WithoutRequiredAuthorization(Y/N)No200 per 27-day periodBilling NotesNoneEffective Dateof ChangePrior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior e/NeedleYesA4223Infusion SupplyNoIntravenous administration set (with or without By Reportinfusion pump), hypodermoclysis administrationset, connecting device, heparin lock capseachNo30 per 27-day periodNonePrior to2/16/2015Infusion set for external insulin pump, nonneedle cannula typeInfusion set for external insulin pump, needletypeSyringe with needle for external insulin pump,sterile, 3ccAlcoholPrior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015A4230Diabetic SupplyNoA4231Diabetic SupplyNoA4232Diabetic cohol wipes or 70% isopropyl alcoholswabsticks 0.0105A4246MiscellaneousNoBetadine or phisohex solutionA4247MiscellaneousNoPovidone-iodine swabsticksA4248MiscellaneousNoA4256Diabetic SupplyNoA4305Infusion SupplyNoA4306Infusion 11NoA4312UrologicalSupplyNoA4313UrologicalSupplyNo 10.07eachNo24 per 27-day periodNone 5.10eachNo24 per 27-day periodNone 2.09eachNo24 per 27-day periodNonemillilitersNo473 milliliters per 81-day periodeachNo200 per 27-day periodBy ReportmillilitersYesNot availableBy ReporteachNo200 per 27-day periodChlorhexidine containing antiseptic, 1 milliliters By ReportmillilitersYesNot availableCode I Restriction - for use whencleansing the skin at central orperipheral catheter exit site duringdressing changes and for intravenousstartsNoneNormal, low and high calibrator solution / chips By ReporteachYesNot availableNoneDisposable drug delivery system, flow rate of50 milliliters or greater per hourDisposable drug delivery system, flow rate ofless than 50 milliliters per hourInsertion tray without drainage bag and withoutcatheter (accessories only)Insertion tray without drainage bag withindwelling catheter, foley type, two-way latexwith coating (teflon, silicone, silicone elastomeror hydrophilic, etc.)Insertion tray without drainage bag withindwelling catheter, foley type, two-way, allsiliconeInsertion tray without drainage bag withindwelling catheter, foley type, three-way, forcontinuous irrigationBy ReporteachYesNot availableNoneBy ReporteachYesNot availableNone 7.33eachNo9 per 81-day periodNone 14.10eachNo9 per 81-day periodNone 17.14eachNo9 per 81-day period 17.59eachNo9 per 81-day periodBy ReportPage 1 of 13Code I Restriction - 91% or 99%isopropyl onlySwabsticks are Code I Restricted - foruse when cleansing the skin at centralor peripheral catheter exit site duringdressing changes and for intravenousstartsNoneDescription ofChangePublication DateNot availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Added text toadditional coverageand billing informationcell, and addedeffective date ofchangeSeptember 2020Not availableMay 2020Not availableMay 2020Not availableMay 2020Not availableMay 2020Not availableSeptember 2017Not availableSeptember 2017Prior to2/16/2015Prior to2/16/2015Not availableSeptember 2017Not availableSeptember 2017Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Not availableSeptember 2017Not availableSeptember 2017NoneNoneNot availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Prior to2/16/2015Not availableSeptember 2017Prior to2/16/2015Not availableSeptember 2017
Medical Supplies Billing Codes, Units and Quantity Limits (mc sup billing)Medical Supplies Billing Codes, Units and Quantity LimitsThis spreadsheet contains medical supply billing codes, unit of measure (UOM) and quantity limits. Refer to the Medical Supplies section of the provider manual for additional information and program coverage. Refer to the appropriate spreadsheet for billing codes restricted tocontracted products. Certain medical supplies must be billed by a pharmacy provider only using the product's 11-digit billing number (NDC). The NDC billed must be an exact match for the product dispensed. This List is subject to change with notification in the provider bulletins.Updates or additions to the spreadsheet will be noted in the “Description of Change" column. Deletions will be on the tab labeled "Medical Supplies Deletions." 'MAPC' refers to the maximum allowable product cost reimbursed.Billing usRestricted toDescriptionMAPC per UnitContractedof MeasureProducts (Y/N)(UOM)NoInsertion tray with drainage bag with indwelling 24.03catheter, foley type, two-way latex with coating(teflon, silicone, silicone elastomer orhydrophilic, etc.)NoInsertion tray with drainage bag with indwelling 25.07catheter, foley type, two-way, all ogicalSupplyOstomy SupplyOstomy SupplyNoNoNoNoNoNoNoInsertion tray with drainage bag with indwelling 26.98catheter, foley type, three-way, for continuousirrigationIrrigation tray with bulb or piston syringe, any 4.30purposeIrrigation syringe, bulb or piston, each 2.89Male external catheter with integral collection 9.35chamber, any type, eachFemale external urinary collection device;By Reportmeatal cup, eachFemale external urinary collection device; 9.93pouch, eachPerianal fecal collection pouch with adhesive, By ReporteachExtension drainage tubing, any type, any length, 3.02with connector/adaptor, for use with urinary legbag or urostomy pouch, eachLubricant, individual sterile packet 0.0290Urinary catheter anchoring device, adhesiveskin attachment, eachUrinary catheter anchoring device, leg strap,eachIndwelling catheter; foley type, two-way latexwith coating (teflon, silicone, silicone elastomer,or hydrophilic, etc.), eachIndwelling catheter; specialty type, eg; coude,mushroom, wing, etc.), eachIndwelling catheter, foley type, two-way, allsilicone, eachIndwelling catheter; foley type, three way forcontinuous irrigation, eachMale external catheter, with or withoutadhesive, disposable, eachIntermittent urinary catheter; straight tip, with orwithout coating (teflon, silicone, siliconeelastomer, or hydrophilic, etc.), eachUOMeachTARQuantity Limits WithoutRequiredAuthorization(Y/N)No9 per 81-day periodBilling NotesDescription ofChangePublication DateNonePrior to2/16/2015Not availableSeptember 2017eachNo9 per 81-day periodNonePrior to2/16/2015Not availableSeptember 2017eachNo9 per 81-day periodNonePrior to2/16/2015Not availableSeptember 2017Prior to2/16/2015Prior to2/16/2015Not availableSeptember 2017Added tomiscellaneouscategoryNot availableSeptember 2020September 2017Not availableSeptember 2017eachNo90 per 81-day periodNoneeachNo90 per 81-day periodNoneeachNo90 per 81-day periodNoneeachYesNot availableNoneeachNo90 per 81-day periodNoneeachYesNot availableNoneeachNo12 per 81-day periodNonegramNo240 grams per 27-day periodCode I Restriction - For use withurological non-hydrophilic cathetersonly.None 7.50eachNo18 per 81-day period 4.68eachNo18 per 81-day periodNone 9.32eachNo105 per 81-day periodNone 23.00eachNo105 per 81-day periodNone 13.00eachNo105 per 81-day periodNone 15.00eachNo105 per 81-day periodNone 1.50eachNo105 per 81-day periodNoneeachNo150 per 27-day periodNoneeachNo150 per 27-day periodNoneeachYesNot availableNoneeachNo9 per 81-day periodNoneeachNo18 per 81-day periodNoneeachYesNot availableNoneeachNo9 per 81-day periodNoneeachNo18 per 81-day periodNoneeacheachNoNo3 per 81-day period90 per 81-day periodNoneNoneRefer to the Listof ContractedIntermittentUrinary CathetersIntermittent urinary catheter; coude (curved) tip, Refer to the Listwith or without coating (teflon, silicone, silicone of Contractedelastomeric, or hydrophilic, etc.), eachIntermittentUrinary CathetersIntermittent urinary catheter, with insertionBy ReportsuppliesInsertion tray with drainage bag but without 11.21catheterIrrigation tubing set for continuous bladder 8.46irrigation through a three-way indwelling foleycatheter, eachExternal urethral clamp or compression device 48.00(not to be used for catheter clamp), eachBedside drainage bag, day or night, with or 9.22without anti-reflux device, with or without tube,eachUrinary drainage bag, leg or abdomen, vinyl, 6.20with or without tube, with straps, eachOstomy faceplate, each 13.45Skin barrier; solid 4" x 4" or equivalent, each 3.90Effective Dateof ChangePage 2 of 13Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Prior to2/16/2015Not availableSeptember 2017Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Prior to2/16/2015Prior to2/16/2015Prior to2/16/20151/1/20191/1/2019Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableNot availableOctober 2018October 2018
Medical Supplies Billing Codes, Units and Quantity Limits (mc sup billing)Medical Supplies Billing Codes, Units and Quantity LimitsThis spreadsheet contains medical supply billing codes, unit of measure (UOM) and quantity limits. Refer to the Medical Supplies section of the provider manual for additional information and program coverage. Refer to the appropriate spreadsheet for billing codes restricted tocontracted products. Certain medical supplies must be billed by a pharmacy provider only using the product's 11-digit billing number (NDC). The NDC billed must be an exact match for the product dispensed. This List is subject to change with notification in the provider bulletins.Updates or additions to the spreadsheet will be noted in the “Description of Change" column. Deletions will be on the tab labeled "Medical Supplies Deletions." 'MAPC' refers to the maximum allowable product cost reimbursed.Billing Code(HCPCS)CategoryRestricted toDescriptionContractedProducts (Y/N)NoOstomy clamp, any type, replacement only,eachNoAdhesive, liquid or equal, any typeNoOstomy vent, any type, eachMAPC per Unitof Measure(UOM) 2.00A4363Ostomy SupplyA4364A4366Ostomy SupplyOstomy SupplyA4367A4368A4369A4371A4372Ostomy SupplyOstomy SupplyOstomy SupplyOstomy SupplyOstomy SupplyNoNoNoNoNoOstomy belt, eachOstomy filter, any type, eachOstomy skin barrier, liquid (spray/brush etc)Ostomy skin barrier, powderOstomy skin barrier, solid 4" x 4" or equivalent;standard wear, built-in convexity, eachA4373Ostomy SupplyNoOstomy skin barrier with flange (solid, flexible 6.36or accordian), with built-in convexity, any size,eachOstomy pouch, drainable with faceplateBy Reportattached, plastic, eachOstomy pouch, drainable with faceplateBy Reportattached, rubber, eachOstomy pouch, drainable for use on faceplate, By Reportplastic, eachOstomy pouch, drainable, for use on faceplate, By Reportrubber, eachOstomy pouch, urinary, with faceplate attached, By Reportplastic, eachOstomy pouch, urinary, with faceplate attached, By Reportrubber, eachOstomy pouch, urinary, for use on faceplate,By Reportplastic, eachOstomy pouch, urinary, for use on faceplate,By Reportheavy plastic, eachOstomy pouch, urinary, for use on faceplate,By Reportrubber, eachOstomy faceplate equivalent, silicone ring, each By ReportA4375Ostomy SupplyNoA4376Ostomy SupplyNoA4377Ostomy SupplyNoA4378Ostomy SupplyNoA4379Ostomy SupplyNoA4380Ostomy SupplyNoNone1/1/2019Not availableOctober 2018Not availableNot availableOctober 2018September 2017 7.50 0.30 0.07 0.2483By ReporteacheachmillilitersgrameachNoNoNoNoYes3 per 81-day period90 per 81-day period180 milliliters per 81-day period180 gm per 81-day periodNot availableNoneNoneNoneNoneNone1/1/2019Prior to2/16/20151/1/20196/1/20161/1/20191/1/2019Prior to2/16/2015Not availableNot availableNot availableNot availableNot availableOctober 2018September 2017October 2018October 2018September 2017eachNo90 per 81-day periodNone1/1/2019Not availableOctober 2018eachYesNot availableNoneeachYesNot availableNoneeachYesNot availableNoneeachYesNot availableNoneeachNo90 per 81-day periodNonePrior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/2015Prior to2/16/20151/1/2019 3.72eachNo90 per 81-day periodNone1/1/2019Not availableOctober 2018 4.50eachNo90 per 81-day periodNone1/1/2019Not availableOctober 2018 8.87eachNo90 per 81-day periodNone1/1/2019Not availableOctober 2018 9.50eachNo90 per 81-day periodNone1/1/2019Not availableOctober 2018 6.91eachNo90 per 81-day periodNone1/1/2019Not availableOctober 2018 7.66eachNo90 per 81-day periodNone6/1/2016Not availableSeptember 2017 9.00eachNo90 per 81-day periodNone1/1/2019Not availableOctober 2018millilitersNo720 milliliters per 81-day periodNone1/1/2019Not availableOctober 2018Prior to2/16/2015Prior to2/16/20151/1/20191/1/20191/1/2019Not availableSeptember 2017Not availableSeptember 2017Not availableNot availableNot availableOctober 2018October 2018October 2018Not availableNot availableOctober 2018September 2017NoA4383Ostomy SupplyNoA4384Ostomy SupplyNoA4385Ostomy SupplyNoOstomy skin barrier, solid 4" x 4" or equivalent, 5.00extended wear, without built-in convexity, eachA4387Ostomy SupplyNoA4388Ostomy SupplyNoA4389Ostomy SupplyNoA4390Ostomy SupplyNoA4391Ostomy SupplyNoA4392Ostomy SupplyNoA4393Ostomy SupplyNoA4394Ostomy SupplyNoOstomy pouch, closed with barrier attached,with built-in convexity (1-Pc), eachOstomy pouch, drainable with extended wearbarrier attached, (1-Pc), eachOstomy pouch, drainable with barrier attached,with built-in convexity (1-Pc), eachOstomy pouch, drainable with extended wearbarrier attached, with built-in convexity (1-Pc),eachOstomy pouch, urinary with extended wearbarrier attached (1-Pc), eachOstomy pouch, urinary with standard wearbarrier attached, with built-in convexity (1-Pc)eachOstomy pouch, urinary with extended wearbarrier attached, with built-in convexity (1-Pc),eachOstomy deodorant with or without lubricant, foruse in ostomy pouchOstomy deodorant for use in ostomy pouch,solid, per tabletOstomy belt w/peristomal hernia supportNoA4397A4398A4399Ostomy SupplyOstomy SupplyOstomy SupplyNoNoNoA4400A4402Ostomy SupplyOstomy/Urological SupplyNoNoIrrigation supply; sleeve, eachOstomy irrigation supply; bag, eachOstomy irrigation supply; cone/catheter, with orwithout brushOstomy irrigation setLubricantPublication DateNoneNoneNoNoDescription ofChange360 per 81-day periodNot availableOstomy SupplyOstomy SupplyEffective Dateof ChangeNoYesOstomy SupplyOstomy SupplyBilling NotesmilliliterseachA4381A4395eachTARQuantity Limits WithoutRequiredAuthorization(Y/N)No6 per 81-day period 0.2510By ReportA4382A4396UOM 0.0781eachYesNot availableNoneeachYesNot availableNoneeachYesNot availableNoneeachYesNot availableNoneeachYesNot availableNoneeachYesNot availableNoneBy ReporteachYesNot availableNoneBy ReporteachYesNot availableNone 4.98 14.50 11.00eacheacheachNoNoNo12 per 81-day period1 per 81-day period1 per 81-day periodNoneNoneNone 50.00 0.0208eachgramNoNo1 per 81-day period240 grams per 27-dayPage 3 of 13NoneFor use with ostomy or urologicalsupplies only1/1/2019Prior to2/16/2015Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableSeptember 2017Not availableOctober 2018
Medical Supplies Billing Codes, Units and Quantity Limits (mc sup billing)Medical Supplies Billing Codes, Units and Quantity LimitsThis spreadsheet contains medical supply billing codes, unit of measure (UOM) and quantity limits. Refer to the Medical Supplies section of the provider manual for additional information and program coverage. Refer to the appropriate spreadsheet for billing codes restricted tocontracted products. Certain medical supplies must be billed by a pharmacy provider only using the product's 11-digit billing number (NDC). The NDC billed must be an exact match for the product dispensed. This List is subject to change with notification in the provider bulletins.Updates or additions to the spreadsheet will be noted in the “Description of Change" column. Deletions will be on the tab labeled "Medical Supplies Deletions." 'MAPC' refers to the maximum allowable product cost reimbursed.Billing Code(HCPCS)CategoryA4404A4405A4406A4407Ostomy SupplyOstomy SupplyOstomy SupplyOstomy SupplyRestricted toContractedProducts (Y/N)NoNoNoNoA4408Ostomy SupplyNoA4409Ostomy SupplyNoA4410Ostomy SupplyNoA4411Ostomy SupplyNoA4412Ostomy SupplyNoA4413Ostomy SupplyNoA4414Ostomy SupplyNoA4415Ostomy SupplyNoA4416Ostomy SupplyNoA4417Ostomy SupplyNoA4418Ostomy SupplyNoA4419Ostomy SupplyNoA4420Ostomy SupplyNoA4421Ostomy SupplyNoA4422Ostomy SupplyNoA4423Ostomy SupplyNoA4424Ostomy SupplyNoA4425Ostomy SupplyNoA4426Ostomy SupplyNoA4427Ostomy SupplyNoA4428Ostomy SupplyNoA4429Ostomy Suppl
Billing Notes Effective Date of Change Description of Change Publication Date Medical Supplies Billing Codes, Units and Quantity Limits This spreadsheet contains medical supply billing codes, unit of measure (UOM) and quantity limits. Refer to the Medical Supplies section of the provider manual for additional information and program coverage.
Part 2 – Medical Supplies: Billing Examples Page updated: August 2020 Tracheostomy Supplies: Contracted Figure 1. Tracheostomy supplies, contracted. This is a sample only. Please adapt to your billing situation. In this example, a Durable Medical Equipment (DME) company is billing for contracted tracheostomy supplies.
Incontinence Medical Supplies Page updated: September 2020 This section contains program coverage and billing information for incontinence medical supplies. The information provided in this section applies to the incontinence medical supplies billing codes and contracted products on the following spreadsheets:
5. The batch will close and so will the OPIE Billing application. 6. To return to OPIE Billing, create a new batch. Get Started in Billing - Set up Global Settings in Billing Admin Rights in OPIE are required to access Billing Settings. 1. Log into OPIE Billing, go to the top left part of the Window to the menus: File, Windows, Help and click .
Consolidated Billing 3 Medicare Part B 3. SNF Billing Requirements 4. Billing Tips 5 Special Billing Situations 6 Readmission Within 30 Days 6 Benefits Exhaust 7 No Payment Billing 8 Expedited Review Results. 9 Noncovered Days 10 Other SNF Billing Situations 10. Resources 12. The American Hospital Association (the " AHA
This streamlines your medical billing beyond what a single in-house biller can do. PrognoCIS EHR software is integrated with Practice Management, meaning that billing and electronic medical records can be managed in a single solution. The company that already organizes your electronic medical records will also handle your medical billing.
The process for an AIA billing in Foundation has a few basic steps: 1. Create an AIA billing record 2. Create a schedule of values for Application 1 3. Print and post the application 4. Repeat as needed 5. Release retainage Create an AIA Billing Record Setting up an overall billing record for your progress billing job in Foundation means two .
billing and collecting fees for services. To maintain a regular cash flow —the move-ment of monies into or out of a business—specific medical billing tasks must be com-pleted on a regular schedule. Processing encounters for billing purposes makes up the pre-claim section of the medical billing cycle. This chapter discusses the important
Business-Level Strategies 23.11.2010 4. What is a Strategic Business Area? Demand Demand potential (size, growth rate, market share) Customers Customer potential customer structure, buying motives and criteria) Competition Structure of the competition, the competitors' objectives and strategies, competitive position Specific resources and competences (the strategic capabilities) Organisation .
