Negative Pressure Wound Therapy Pumps and Ostomy Supplies

Negative Pressure Wound Therapy Pumps

    For Medicare Part B covered patients, the four regional Durable Medical Equipment Regional Carriers (DMERCs) have written Local Coverage Decisions (LCDs) for negative pressure wound therapy pumps and supplies, which outline:

  • Indications and limitations of coverage and/or medical necessity
  • CPT/HCPCS codes
  • Reasons for denials
  • Coding guidelines
  • Documentation requirements
  • Other comments

    Wound care providers should study their DMERC’s LCDs, which will help them determine: 1) if their patients’ wounds qualify for negative pressure wound therapy, 2) documentation required, 3) physician’s ordering requirements, 4) amount of supplies covered, 5) descriptions of negative pressure wound therapy equipment and supplies HCPCS codes, and related information.

    The 2005 HCPCS codes and DMERC ceiling/floor payment rates and copayment rates are listed in Table 1. Providers should be sure patients using negative pressure wound therapy pumps and supplies understand their co-payment responsibilities.

Ostomy Supplies

    For Medicare Part B covered patients, the four regional Durable Medical Equipment Regional Carriers (DMERCs) have written Local Coverage Decisions (LCDs), for the use of ostomy supplies, which outline:
• Indications and limitations of coverage and/or medical necessity
• CPT/HCPCS Codes
• ICD-9 Codes that support medical necessity
• Reasons for denials
• Coding guidelines
• Documentation requirements

    Wound care providers should study their DMERC’s LCDs, which will help them determine: 1) physician’s ordering requirements, 2) types of ostomies that are covered, 3) the quantity of ostomy supplies allowed, 4) full descriptions of ostomy HCPCS codes, 5) documentation required to support the need for the ostomy supplies ordered and provided, and related information.

    The 2005 HCPCS codes and DMERC ceiling/floor payment rates and copayment rates are listed in Table 2. Providers should be sure patients using ostomy supplies understand their copayment responsibilities.