(Medicare Benefit Policy Manual)

Examples of supplies which are usually considered routine include, but are not limited to:   A.  Dressings and Skin Care    Swabs, alcohol preps, and skin prep pads;   Tape removal pads;   Cotton balls;   Adhesive and paper tape;   Nonsterile applicators; and   4 x 4's.  B.  Infection Control Protection    Nonsterile gloves;   Aprons;   Masks; and   Gowns.   C.  Blood Drawing Supplies    Specimen containers.   D.  Incontinence Supplies    Incontinence briefs and Chux Covered in the normal course of a visit.  For example, if a home health aide in the course of a bathing visit to a patient determines the patient requires an incontinence brief change, the incontinence brief in this example would be covered as a routine m edical supply.   E.  Other   Thermometers; and   Tongue depressors.   There are occasions when the supplies listed in the above examples would be considered nonroutine and thus would be considered a billable supply, i.e., if they are required in quantity, for recurring need, and are included in the plan of care.  Examples include, but are not limited to, tape, and 4x4s for major dressings.   50.4.1.3 - Nonroutine Supplies (Reportable)  (Rev. 10438, Issued: 11- 06-20, Effective: 03 -01-20, Implementation: 01-  11-21)  Nonroutine supplies are identified by the following conditions:   1.  The HHA follows a consistent charging practice for Medicare and other patients receiving the item;   2.  The item is directly identifiable to an individual patient;  3.  The cost of the item can be identified and accumulated in a separate cost center; and  4.  The item is furnished at the direction of the patient's physician or allowed practitioner and is specifically identified in the plan of care.   All nonroutine supplies must be specifically ordered by the physician or allowed practitioner or the physician or allowed practitioner's order for services must require the use of the specific supplies to be effectively furnished.  The charge for nonroutine supplies is excluded from the per visit costs.  Examples of supplies that can be considered nonroutine include, but are not limited to:   1.  Dressings/Wound Care    Sterile dressings;  Sterile gauze and toppers;   Kling and Kerlix rolls;   Telfa pads;   Eye pads;   Sterile solutions, ointments;   Sterile applicators; and   Sterile gloves.   2.  I.V. Supplies   3.  Ostomy Supplies   4.  Catheters and Catheter Supplies    Foley catheters; and   Drainage bags, irrigation trays.  5.  Enemas and Douches   6.  Syringes and Needles   7.  Home Testing    Blood glucose monitoring strips; and   Urine monitoring strips.  Consider other items that are often used by persons who are not ill or injured to be medical supplies only where:    The item is recognized as having the capacity to serve a therapeutic or diagnostic purpose in a specific situation; and   The item is required as a part of the actual physician or allowed practitioner prescribed treatment of a patient's existing illness or injury.  For example, items that generally serve a routine hygienic purpose, e.g., soaps and shampoos and items that generally serve as skin conditioners, e.g., baby lotion, baby oil, skin softeners, powders, lotions, are not considered medical supplies unless the particular item is recognized as serving a specific therapeutic purpose in the physician or allowed practitioner's prescribed treatment of the patient's existing skin (scalp) disease or injury.   Limited amounts of medical supplies may be left in the home between visits where repeated applications are required and rendered by the patient or other caregivers.  These items must be part of the plan of care in which the home health staff is actively in volved.  For example, the patient is independent in insulin injections but the nurse visits once a day to change wound dressings.  The wound dressings/irrigation solution may be left in the home between visits.  Supplies such as needles, syringes, and catheters that require administration by a nurse should not be left in the home between visits.   50.4.2 - Durable Medical Equipment  (Rev. 1, 10- 01-03) A3-3119.4.B, HHA -206.4.B   Durable medical equipment which meets the requirements of the Medicare Benefit Policy Manuals, Chapter 6, "Hospital Services Covered Under Part B," 80, and Chapter 15, Covered Medical and Other Health Services 110, is covered under the home health benefit with the beneficiary responsible for payment of a 20 percent coinsurance.   50.4.3  Covered Osteoporosis Drugs  (Rev. 10438, Issued: 11- 06-20, Effective: 03 -01-20, Implementation: 01-  11-21)  Sections 1861(m) and 1861(kk) of the Act provide for coverage of FDA approved injectable drugs for the treatment of osteoporosis.  These drugs are expected to be provided by an HHA to female beneficiaries who are currently receiving services under an open home health plan of care, who meet existing coverage criteria for the home health benefit and who meet the criteria listed below.  These drugs are covered on a cost basis when provided by an HHA under the circumstances listed below.   The home health visit (i.e., the skilled nurse's visit) to administer the drug is covered under all fee -for-service Medicare (Part A or Part B) home health coverage rules (see section 30 above).  Coverage of the drug is limited to female beneficiaries who meet each of the following criteria:   o The individual is eligible for Medicare Part B coverage of home health services (the nursing visit to perform the injection may be the individual's qualifying service);   o The individual sustained a bone fracture that a physician, or allowed practitioner, or certified nurse midwife certifies was related to post -menopausal osteoporosis; and  o The individual's physician, or allowed practitioner, or certified nurse midwife certifies that she is unable to learn the skills needed to self -administer the drug or is otherwise physically or mentally incapable of administering the drug, and that her fam ily or caregivers are unable or unwilling to administer the drug.   This drug is considered part of the home health benefit under Part B.  Therefore, Part B deductible and coinsurance apply regardless of whether home health visits for the administration of the drug are covered under Part A or Part B.  For instructions on billing for covered osteoporosis drugs, see Pub. 100- 04, Medicare Claims Processing Manual, chapter 10, section 90.1.  50.4.4 - Negative Pressure Wound Therapy Using a Disposable Device  (Rev. 12382; Issued: 11- 28-23; Effective: 01 -01-24; Implementation:01- 02-24)  For services furnished on or after January 1, 2017 and before January 1, 2024, sections 1834 and 1861(m)(5) of the Act required a separate payment to an HHA for an applicable disposable device, to an individual who received  home health services for which  payment  was made under  the Medicare home  health  benefit.  Section  1834 of the Act defines  an applicable device as a disposable NPWT device that is an integrated system comprised of a non- manual vacuum pump, a receptacle for collecting exudate, and dressings for the purposes of wound therapy used in lieu of a conventional NPWT DME system. As required by 1834 of the Act, the separate payment amount for a disposable NPWT device was set equal to the amount of the payment that would be made under the Medicare Ho spital Outpatient Prospective Payment System (OPPS) using the Level I HCPCS code, otherwise referred to as Current Procedural Terminology (CPT) codes, for which the description for a professional service includes the furnishing of such a device.   Payment for HH visits related to wound care, but not requiring the furnishing of an entirely new disposable NPWT device, were covered by the HH PPS period payment and were billed using the HH claim.  Where a home health visit was  exclusively for the purpose of furnishing NPWT using a disposable device, the HHA submitted  only a type of claim that was paid for separately outside the HH PPS (TOB 34x). Where, however, the home health visit included the provision of other home health services in addition to, and separate from, furnishing NPWT using a disposable device, the HHA submitted  both a home health claim and a TOB 34x the  home  health  claim  for other  home  health  services  and the TOB  34x for furnishing NPWT  using a disposable device.   EXAMPLE:   A patient requires dNPWT for the treatment of a wound. On Monday, a nurse assesses a patients wound, applies a new disposable NPWT device, and provides wound care education to the patient and family.  The nurse returns on Thursday for wound assessment and replaces the fluid management system (or dressing) for the  existing  disposable  NPWT,  but does not replace the entire  device.  The nurse  returns  the following Monday, assesses the patients condition and the wound, and replaces the device that had been applied on the previous Monday with a new disposable NPWT device.  In this scenario, the billing procedures are as follows:   For both Monday visits, all the services provided by the nurse were associated with furnishing NPWT using a disposable  device.  The nurse  did not provide  any services  that were not associated  with furnishing NPWT  using a disposable device. Therefore, all the nursing services for both Monday visits should be reported on TOB 34x with CPT code 97607 or 97608. None of the services should be reported on the HH claim.   For the Thursday visit,  the nurse  checked  the wound, but did not apply a new disposable  NPWT  device,  so even though the nurse  provided care related  to the wound,  those  services  would not  be considered  furnishing NPWT  using a disposable  device.  Therefore,  the services  should be reported  on bill type 32x and no services  should be reported on bill type 34x.   For services furnished on or after January 1, 2024, Division FF, section 4136 of the Consolidated Appropriations Act of 2023 (CAA, 2023) (Pub. L.117- 328) requires that beginning in CY 2024, there will be a separate payment amount for an applicable dNPWT device only and does not include payment for the nursing and therapy services.  Payment for the device is equal to the supply price used to deter mine the relative value for the service under the Medicare Physician Fee Schedule (as of January 1, 2022) for the applicable disposable device and updated by the consumer price index for all urban consumers minus the productivity adjustment for each future  year.   Payment for nursing or therapy services, described in section 1861(m), to apply a disposable NPWT device would now be made under the prospective payment system established under section 1895, the HH PPS, and is no longer separately billable. Additionally, beginning in CY 2024 and each subsequent year, claims for the separate payment amount of an applicable dNPWT device would now be accepted and processed on claims submitted using the type of bill that is most commonly used by home health agencies to bill se rvices under a home health plan of care (TOB 032x). That is, claims with a date of service on or after January 1, 2024 for an applicable dNPWT device will no longer be submitted on TOB 034x.   EXAMPLE:   A patient requires dNPWT  for the treatment of a wound. On Monday, a nurse assesses a patients wound, applies a new disposable NPWT device, and provides wound care education to the patient and family.  The nursing visit is reported on the home health claim as a home health visit using the appropriate G -code, revenue code and units of time on TOB 032x. Payment for these services are included in the overall HH PPS payment rate for the 30-day period of care if the LUPA threshold has been met for the period. The HHA would report the H ealthcare Common Procedure Coding System (HCPCS) code A9272 (for the device only) on the home health type of bill TOB 032x. A separate payment is made for the device only. The nurse returns on Thursday for follow up teaching and assessment of the device. T he nurse does not replace the dNPWT device at this visit. Only the nursing visit is reported on the home health claim using TOB 032x. No separate reporting for the device would be included on the claim since the device was not replaced during this visit.