(Medicare Claims Processing Manual)

Durable Medical Equipment (DME), including prosthetics, orthotics and oxygen, is exempt from home health consolidated billing by law.  For detailed information regarding home health consolidated billing, DMEPOS suppliers should refer to chapter 10, section 20 of this manual.  213- Billing for Home IVIG Items and Services  (Rev. 12437, Issued: 12- 28-23, Effective: 01 -01-24, Implementation: 01- 02-24)  Effective January 1, 2024, Medicare makes a separate bundled payment for home intravenous immune globulin (IVIG) items and services to DME suppliers. This payment amount covers the cost of nursing services and supplies including an infusion set and tubing, for the provision of IVIG administration in  the home by a DME supplier.    The items and services payment is made per visit for days on which the IVIG is administered by a nurse in the patients home. The patient must have a diagnosis of Primary Immune Deficiency Disease (PIDD) as indicated in the Intravenous Immune Globulin Poli cy Article (A5209). Payment for home IVIG items and services is only made when the patient is receiving one of the IVIG products listed on the Local Coverage Determination (LCD) for Intravenous Immune Globulin (L33610).   A single payment will be made for the items and services provided on the calendar day when such items and services are furnished in the home. The HCPCS (Q2052) Services, Supplies, and Accessories used in the Home for the Administration of Intravenous Immune Globulin) will be billed separately from, or on the same claim as, the J -code for the IVIG product. The Q -code should be billed as a separ ate claim line on the same claim for the same place of service as the J-code for the IVIG. In cases where the IVIG  product is mailed or delivered to the patient prior to administration, the date of service for the administration of the IVIG (the Q -code) may be no more than 30 calendar days after the date of service on the IVIG product claim line. No more than one Q -code should be billed per claim line per date of service.   If a provider is billing for multiple administrations of IVIG on a single claim, then the supplier would bill the Q -code for each date of service on a separate claim line, which would be payable per visit (that is, each time the IVIG is administered). Ther e may be situations in which multiple units of IVIG are shipped to the patient and billed on a single J code claim line followed by more than one Q -code administration claim line, each with the date of service on which the IVIG was administered. However, only one unit of service (Q -code) shall be paid per infusion date of service.   Providers should report visit length in 15- minute increments (15 minutes=1 unit) ) when billing for IVIG (Q2052) . See the table below for the rounding of units.    Rounding of Time Units   Unit Time  1 <23 minutes  2 = 23 minutes to <38 minutes  3 = 38 minutes to <53 minutes  4 = 53 minutes to <68 minutes  5 = 68 minutes to <83 minutes  6 = 83 minutes to <98 minutes  7 = 98 minutes to <113 minutes  8 = 113 minutes to <128 minutes  9 = 128 minutes to <143 minutes  10 = 143 minutes to <158 minutes    A submitted claim for home IVIG items and services is subject to a Common Working File (CWF) edit in the event that an IVIG J -code is not found on the same claim as the IVIG items and services payment code (Q -code), or in claims history in the previous 30 days. If a J -code is not found on the same claim as the Q -code, the claims processing system will recycle the Q -code claim for the IVIG items and services associated with the administration of the IVIG product (J -code), until a claim containing the J -code for IVIG product is received in the CWF. The home IVIG items and services claim will recycle three times (with a 30 -day look back period) for a total of 15 business days. After 15 business days, if no J -code claim is found in claims history, the Q -code cla im will be denied.   Suppliers must ensure that an eligible J -code (as indicated on L33610) associated with the visit is billed with the visit or no more than 30 days prior to the visit. Visits are denied if an eligible J -code for the visit is not billed. Claims reporting mult iple visits on the same line item date of service will be returned as unprocessable.  220 - Appeals  (Rev. 1, 10- 01-03)  See chapter 29 for a description of the appeals process.   230 - DME MAC Systems (Rev. 629, Issued:  07- 29-05; Effective:  01 -01-06; Implementation:  01 -03-06)  The VMS shall allow the DME MACs  the flexibility to report CMN edits as medical review or claims processing workload.    300 - New Systems Requirements  (Rev. 166, 4- 30-04)  The DME MAC systems have the capability to turn off the remit switch when sending a remittance notice is not appropriate (e.g. when the beneficiary has submitted a claim).  Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12437CP  12/28/2023 Implementation of the New Home Intravenous Immune Globulin (IVIG) Items and Services Payment  01/02/2024  13217  R12423CP  12/20/2023 Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92  01/02/2024  13222  R12379CP  11/22/2023 Implementation of New Benefit Category for Lymphedema Compression Treatment Items  01/02/2024  13286 R12359CP  11/09/2023 Implementation of New Benefit Category for Lymphedema Compression Treatment Items - Rescinded and replaced by transmittal  12379  01/02/2024  13286  09/14/2023 Implementation of the New Home Intravenous Immune Globulin (IVIG) Items and Services Payment - Rescinded and replaced by transmittal -12437  01/02/2024  13217  07/28/2023 Implementation of New Benefit Category for Lymphedema Compression Treatment Items - SENSITIVE CONTROVERSIAL - Rescinded and replaced by transmitta l 12359/ NO LONGER SENSITIVE   01/02/2024  13286  07/21/2023 Implementation of the New Home Intravenous Immune Globulin (IVIG) Items and Services Payment - SENSITIVE CONTROVERSIAL - Rescinded and replaced by transmittal  12252  01/02/2024  13217 R12013CP  05/02/2023 Inflation Reduction Act Section 11407: Limitations on Monthly Coinsurance and Adjustments to Supplier Payment Under Medicare Part B for Insulin Furnished Through Durable Medical Equipment (DME)  IMPLEMENTATION  07/03/2023  13014 R11917CP  03/21/2023 Inflation Reduction Act Section 11407: Limitations on Monthly Coinsurance and Adjustments to Supplier Payment Under Medicare Part B for Insulin Furnished Through Durable Medical Equipment (DME)  IMPLEMENTATION - Rescinded and replaced by transmittal 12013  07/03/2023  13014 Rev #  Issue Date  Subject  Impl Date  CR#  R11834CP  02/02/2023 Inflation Reduction Act Section 11407: Limitations on Monthly Coinsurance and Adjustments to Supplier Payment Under Medicare Part B for Insulin Furnished Through Durable Medical Equipment (DME)  IMPLEMENTATION   NO LONGER SENSITIVE - Rescinded and replaced by transmittal 11917  07/03/2023  13014 R11429CP  05/23/2022 Revisions to National Coverage Determination (NCD) 240.2 (Home Use of Oxygen) and 240.2.2 (Home Oxygen Use for Cluster Headache)  01/03/2023  12607 R11414CP  05/12/2022 Claims Processing Manual Update -  Pub. 100.04 for Elimination of Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Forms (DIFs)  06/13/2022  12734 R11263CP  02/10/2022 Revisions to National Coverage Determination (NCD) 240.2 (Home Use of Oxygen) and 240.2.2 (Home Oxygen Use for Cluster Headache) - Rescinded and replaced by transmittal 11429 06/14/2022  12607 R10840CP  06/11/2021 Updates to the Internet Only Publication 100-04, Chapter 1, Section 10.1 and Chapter 20, Section 10 07/12/2021  12310 R10236CP  07/31/2020 Update to the IOM Publication (Pub) 100- 04, Medicare Claims Processing Manual, Chapters 1, 6, 8, 17, 20, 22, 24, and 31 Referencing the Active Universal Resource Locators (URLs) for the Washington Publishing Company (WPC) and the ASC X12 Organizations, and Updates to the HIPAA Eligibility Transaction System (HETS)  08/31/2020  11857  12/20/2019 Manual Update to Publication (Pub.) 100- 04, Chapter 20, to Revise the Subsection 10 -  Where to Bill Durable Medical Equipment, Prosthetics, Orthotics, and Supplies 03/23/2020  11554 Rev #  Issue Date  Subject  Impl Date  CR#  (DMEPOS) and Parenteral and Enteral Nutrition (PEN) Items and Services  R4202CP  01/18/2019 Update to Pub. 100- 04 Chapters 8, 20, and 24 to Provide Language -Only Changes for the New Medicare Card Project  02/19/2019  10964 R4112CP  11/01/2018 Temporary Transitional Payment for Home Infusion Therapy Services for CYs 2019 and 2020 01/07/2019  10836 R4052CP  05/17/2018 Removal of KH Modifier from Capped Rental Claims  10/01/2018  10422 R4037CP  04/27/2018 Removal of KH Modifier from Capped Rental Claims -  Rescinded and replaced by transmittal 4052  10/01/2018  10422 R4027CP  04/27/2018 Inexpensive or Routinely Purchased Durable Medical Equipment (DME) Payment Classification for Speech Generating Devices (SGD) and Accessories