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Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing

Quarterly Update of HCPCS Codes Used for Home Health Consolidated Billing March 21, 2013

March 15, 2013, the Centers for Medicare and Medicaid Services (CMS) published an MLN Matters article addressing the quarterly update of HCPCS codes used for home health (HH) consolidated billing enforcement.  The article is based on the annual update to the HH consolidated billing effective July 1, 2013.  The update adds the following codes to the HH consolidated billing therapy code list:

  • G0456 – Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters
  • G0457 – Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters

Services appearing on the consolidated list, that are submitted on claims to Medicare, will not be paid separately on dates when a beneficiary is in a HH episode with the exception of the following:

  • Therapies performed by physicians
  • Supplies incidental to physician services; and
  • Supplies used in institutional settings

Medicare will only directly reimburse the primary HHAs that have opened such episodes during the episode periods.

The MLN Article may be found at the following location:  http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8246.pdf.

DISCLAIMER:  This post contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations given is general and specific questions should be directed to professional counsel.

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