Article Detail - JA DME

For the benefit of the supplier community, Noridian wishes to clarify that supply allowance codes A4436 (irrigation supply; sleeve, reusable, per month) and A4437 (irrigation supply; sleeve, disposable, per month) are for a month's irrigation sleeve supply allowance. One unit of service would be billed regardless of how many sleeves are required. If the beneficiary requires more than the monthly limit of four sleeves, the supplier must deliver the additional sleeves to the beneficiary. Below is an excerpt from the CMS Medicare Learning Network (MLN) MM12521 - Calendar Year 2022 Update for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule that discusses a one-month supply, not one sleeve a month.

"The irrigation supply sleeve code A4397 is divided into separate reusable and disposable irrigation sleeve codes. The fee schedule amount for one month of the sleeves is equivalent to the A4397 fee schedule amount multiplied by the monthly use limit of four. Therefore, the current monthly fee schedule amounts will continue to apply to codes A4436 and A4437 effective January 1, 2022. Medicare pays in advance for the month’s supply of irrigation sleeves and suppliers must ensure that the patient has enough sleeves to last for the entire month. If the patient needs more replacement sleeves before the end of the month, the supplier must deliver the additional sleeves to the patient."