Author Topic: How to get a new product a code or payable under an existing code?  (Read 769 times)

LoriAZ84

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Hi-
I was just hired on at a small local company that sells drug transport and monitoring system carriers (think of a thick band that has compartments for pumps, tubes, wires, etc. that is worn under clothing). The owner has a contract with a large infusion pump company and they mostly use the carriers for incentives to get more practices and hospitals interested in their product but do not bill for the carrier. The owner would like to see if it is possible to get a code for her product, whether a new one or under an existing one but I am at a loss for how to go about this. If anyone has any suggestions or can at least point me in the right direction, I would be greatly appreciative.
Thank you,
Lori

Merry

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Re: How to get a new product a code or payable under an existing code?
« Reply #1 on: April 02, 2014, 09:59:59 PM »
Sounds like this would come under DME supplies but the way I read it,  it would be a convenience but not medically necessary.  Call the DMERC  MAC for your area and start there.  Sounds like a great idea but more of a convenience product which probably would not be covered but you never know.  Definitely start there.  And please keep us updated. 

RichardP

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Re: How to get a new product a code or payable under an existing code?
« Reply #2 on: April 02, 2014, 10:17:10 PM »
See the first paragraph at Page 2 of this link if you are not familiar with HCPCS:

http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/HCPCSReform.pdf

Here is the application form plus related words:

http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/HCPCS_Application.pdf

The third paragraph of the application begins You may submit a recommendation to establish, revise or discontinue a code, using the attached, standard format.  But, in support of Merry's point, the second paragraph of the application says:

As a preliminary step in the process for recommending a modification to the HCPCS Level II coding system, it may be helpful for you to contact 3rd party payers for Medicare, Medicaid and private insurers to determine if, in their determination, existing HCPCS codes identify the item.

You might find this link useful also, although it is targeted at Medicaid issues:

http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/Medicaid_Pilot_HCPCS.pdf
« Last Edit: April 02, 2014, 10:21:40 PM by RichardP »