Updates From Ronda's Desk - From Correct Coding of "No Touch" Catheters to C2C Solutions Reopening Requests

Posted on in Billing/Reimbursement

from-rhondas-deskCatheters—Correct Coding of “No-Touch”

For those suppliers that supply catheters, be sure to read this Correct Coding and Coverage of Ventilators article regarding the correct coding of the no-touch catheter under HCPCS A4353 being sure it meets the requirements.

Vacuum Erection Devices

Under the Achieving a Better Life Experience (ABLE) Act of 2014, the Vacuum Erection Devices (VED) are no longer covered under Medicare for dates of service on or after July 1, 2015. The medical policies and related articles will be revised to reflect this change.


Ventilators have been a hot topic in the industry these days. We have seen articles released about accreditation changes, correct coding and coverage of ventilators, and the results of the prepayment reviews for the NIV HCPCS E0464. It’s also been shared that the prepayment reviews will continue in Jurisdiction A, Jurisdiction D, and now Jurisdiction C is performing these reviews on the NIV, E0464. I have included the articles plus the results of the prepayment reviews. Take a look at the information and be sure you are implementing this into your policies. If you or anyone on your team has a question, please be sure to reach out to me.
  1. Ventilator Accreditation
  2. Correct Coding and Coverage of Ventilators
  3. Results of Prepayment Reviews: Jurisdiction A and Jurisdiction D.
Please contact me with any questions. Ronda Buhrmester, CRT Reimbursement Specialist O: 888-665-6518 Twitter: @RondaBuhrmester

Reminder: C2C Solutions Still Taking Reopening Requests

If you receive a denial from C2C Solutions (Reconsideration) and the denial was a technical denial (NOT a medical necessity) and you wish to explain that they made an error or did not actually see the item that you sent in, a reopening can be requested. Example of this type of denial: The request was denied due to no physician’s signature on the report or ATP certification not received, but it was sent with numbered pages and you have a fax confirmation of the pages sent. If you wish to request a reopening, please complete the C2C Solutions Reopening Request Form and fax it to the Reimbursement Team for review. The Reimbursement Team will make sure your request is in order and then send it to C2C Solutions to request reprocessing. C2C Solutions Provider Inquiry Form Please complete the form clearly and legibly and include a good contact phone number for follow-up. No additional documentation will be sent, just the form. If you have questions, please contact Reimbursement Team or contact our Special Projects Consultant, Peggy Walker. Peggy Walker, RN Special Project Consultant P: 800-401-3643 F: 877-907-3862