July Quarterly Update for 2009 for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

• The following table identifies the 2009 fees for the Healthcare Common Procedure Codes System (HCPCS) codes K0739/E1340. The * denotes revised for the 2009 fee schedule.  

State	HCPCS Codes K0739/E1340	State	HCPCS Codes K0739/E1340
AK*	25.27	MT	13.41
AL*	13.41	NC	13.41
AR*	13.41	ND*	16.72
AZ*	16.59	NE	13.41
CA*	20.58	NH*	14.40
CO*	13.41	NJ*	18.10
CT*	22.40	NM*	13.41
DC*	13.41	NV*	21.37
DE*	24.71	NY*	24.71
FL*	13.41	OH*	13.41
GA*	13.41	OK	13.41
HI*	16.59	OR	13.41
IA*	13.41	PA*	14.40
ID*	13.41	PR	13.41
IL	13.41	RI*	15.99
IN	13.41	SC	13.41
KS	13.41	SD*	14.99
KY	13.41	TN	13.41
LA	13.41	TX	13.41
MA*	22.40	UT*	13.45
MD	13.41	VA	13.41
ME*	22.40	VI	13.41
MI	13.41	VT*	14.40
MN	13.41	WA*	21.37
MO	13.41	WI	13.41
MS	13.41	WV	13.41
WY*	18.70

• The 2009 allowed payment amounts for HCPCS codes E1340/K0739 are revised as part of this quarterly update to reflect updates that were brought to CMS’ attention. The allowed payment amounts (listed above) for HCPCS codes E1340/K0739 are effective as follows:
  • For claims with dates of service from January 1, 2009, through March 31, 2009, submitted using HCPCS code E1340 (Repair or Non-routine Service for DME Requiring the Skill of a Technician, Labor Component, Per 15 Minutes)
  • For claims with dates of service from April 1, 2009, through December 31, 2009, submitted using HCPCS code K0739 (Repair or Non-routine Service for DME Other Than Oxygen Equipment Requiring the Skill of a Technician, Labor Component, Per 15 Minutes)
• Medicare contractors will adjust previously processed claims for HCPCS code E1340/K0739 with dates of service on or after January 1, 2009, through June 30, 2009, if they are resubmitted as adjustments 
• HCPCS codes A6545, E0656, E0657 and L0113 were added to the HCPCS file effective January 1, 2009. The fee schedule amounts for these HCPCS codes are established as part of this update and are effective for claims with dates of service on or after January 1, 2009. These items were paid on a local fee schedule basis prior to implementation of the fee schedule amounts established in accordance with this update. Claims for the above codes with dates of service on or after January 1, 2009, that have already been processed will not be adjusted to reflect the newly established fees if they are resubmitted for adjustment. 
• As part of this update CMS is adding the HCPCS modifier AW to the fee schedule file for HCPCS code A6545 Gradient Compression Wrap, Non-Elastic, Below Knee, 30-50 MM HG, Each. HCPCS code A6545 is covered when it is used in the treatment of an open venous stasis ulcer. Currently, HCPCS code A6545 is noncovered for the following conditions:
  • Venous insufficiency without stasis ulcers, prevention of stasis ulcers, prevention of the reoccurrence of stasis ulcers that have healed and treatment of lymphedema in the absence of ulcers. In these situations, since an ulcer is not present, the gradient compression wraps do not meet the definition of a surgical dressing. Suppliers are advised that when the non-elastic gradient compression wrap HCPCS code A6545 is used in the treatment of an open venous stasis ulcer, it must be billed with the HCPCS modifier AW. Claims for HCPCS code A6545 that do not meet the covered indications should be billed without the HCPCS modifier AW and as such, will be denied as non-covered.
• As part of this update, the fee schedule amounts for HCPCS code K0606 (Automatic External Defibrillator, with Integrated Electrocardiogram Analysis, Garment Type) billed without the HCPCS modifier KF are being removed from the DMEPOS fee schedule file
• A one-time notification regarding the changes in payment for oxygen and oxygen equipment as a result of the MIPPA of 2008 and additional instructions regarding payment for DMEPOS was issued on December 23, 2008, (Transmittal 421, Change Request (CR) 6297). A related MLN Matters® article may be reviewed at www.cms.hhs.gov/mlnmattersarticles/downloads/MM6297.pdf (PDF, 136 KB)). CR 6297 included 2009 labor payment rates for HCPCS codes E1340, L4205 and L7520.
• In 2009, HCPCS code K0739 was established in the HCPCS file to replace HCPCS code E1340 for Medicare claims for the repair of beneficiary-owned DME with dates of service on or after April 1, 2009 (see Transmittal 443, CR 6296 issued on February 13, 2009 which may be reviewed at www.cms.hhs.gov/transmittals/downloads/R443OTN.pdf (PDF, 138 KB)). The 2009 allowed payment amounts for HCPCS code E1340 mapped directly to HCPCS code K0739.

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