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CMS Proposes Change to Payment for Miscellaneous Codes (E1399 and K0108)

Posted on in Billing/Reimbursement

MiscCodesWhat does this mean? HCPCS code E1399 describes “durable medical equipment, miscellaneous” and is currently being used to bill for inexpensive DME and replacement parts of DME. HCPCS code K0108 describes a “wheelchair component or accessory, not otherwise specified” and is currently being used to bill for inexpensive DME, other covered DME and replacement parts of wheelchairs. Currently, payment under codes E1399 and K0108 is based on a percentage of MSRP. The proposed change will be made effective on Jan. 1, 2016, for Medicare claims processing purposes. The HCPCS codes E1399 and K0108 will be split into codes for: a) inexpensive DME; b) other DME or expensive DME; and c) replacement parts for DME being repaired. The following HCPCS codes would replace codes E1399 and K0108, which will be made invalid for Medicare claims processing purposes:

  1. KXXX1 Durable Medical Equipment, Miscellaneous, the Purchase Price Does Not Exceed $150
  2. KXXX2 Durable Medical Equipment, Miscellaneous, the Purchase Price Exceeds $150
  3. KXXX3 Wheelchair Component or Accessory, Miscellaneous, the Purchase Price Does Not Exceed $150
  4. KXXX4 Wheelchair Component or Accessory, Miscellaneous, the Purchase Price Exceeds $150
  5. KXXX5 Repair Part For Use With Beneficiary Owned Durable Medical Equipment, Other Than Wheelchair, Not Covered Under Supplier Or Manufacturer Warranty, Not Otherwise Specified
  6. KXXX6 Repair Part For Use With Beneficiary Owned Wheelchair, Not Covered Under Supplier Or Manufacturer Warranty, Not Otherwise Specified Payment of covered items described by codes KXXX5 and KXXX6 will be made on a lump sum purchase basis in an amount that is based on the contractor’s individual consideration of the item.
Codes KXXX1 and KXXX3 are to be used if the supplier’s actual charge for purchase of the item is $150 or less, or, for rental claims, if the supplier’s actual charge for rental of the item is $15 or less. If the supplier’s actual charge exceeds these thresholds, codes KXXX2 or KXXX4 should be used. Payment of covered items described by codes KXXX1 and KXXX3 will be made in accordance with the rules at 42 C.F.R. 414.220 for inexpensive items, with payment on a purchase or rental basis, and with total payments limited to the purchase fee schedule amount for the item. The law mandates that the fee schedule amounts for inexpensive DME items be based on average reasonable charges for inexpensive DME items from July 1, 1986, through June 30, 1987. The 2015 fee schedule amount generated based on this calculation for KXXX1 is $97.94. The 2015 fee schedule amount generated based on this calculation for the KXXX3 is $72.56. The 2015 capped rental fee schedule amount generated based on this calculation for KXXX2 is $80.60 for rental months 1 thru 3 and $60.45 for months 4 thru 13. The 2015 fee schedule amount generated based on this calculation for the KXXX4 is $53.41 for months 1 through 3 and $40.06 for months 4 through 13. Payment of covered items described by codes KXXX5 and KXXX6 will be made on a lump sum purchase basis in an amount that is based on the contractor’s individual consideration of the item. All of these amounts will be updated by the 2016 covered item update for use in paying claims with dates of service on or after Jan. 1, 2016. Comments DUE by COB Thursday, July 9, 2015. CMS will accept electronic comments on this issue that are submitted on or before Thursday, July 9, 2015. Comments may be submitted via email to CodingComments@cms.hhs.gov . Please include “Miscellaneous Code Comments” in the subject line when sending comments to this mailbox. Dan Fedor Reimbursement Specialist VGM & Associates dan.fedor@vgm.com Phone: 844.794.8459 Fax: 844.307.5729

 

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