|Physician Letter - Continued Medical Necessity [PDF]||This letter reminds physicians that ongoing need for and use of a DMEPOS item must be documented in patient's record|
- General documentation requirements must be met in addition to the coverage criteria. This includes refill requirements and proof of delivery requirements.
- Modifiers A1 - A9 have been established to indicate that a particular item is being used as a primary or secondary dressing on a surgical or debrided wound and also to indicate the number of wounds on which that dressing is being used. The modifier number must correspond to the number of wounds on which the dressing is being used, not the total number of wounds treated. For example, if the patient has four (4) wounds but a particular dressing is only used on two (2) of them, the A2 modifier must be used with that HCPCS code. Modifiers A1-A9 are not used with codes A6531 and A6532. When tape codes A4450 and A4452 are used with surgical dressings, they must be billed with the AW modifier (in addition to the appropriate A1-A9 modifier).
- The RT and/or LT modifiers must be used with codes A6531, A6532, and A6545 for gradient compression stockings and wraps.
- When dressing codes are billed for items covered under another benefit (e.g., gauze for a continent ostomy which is covered under the prosthetic device benefit) claims must be billed according to the documentation requirements specified in the applicable policy (see Ostomy Supplies policy for details).
- No more than a one month's supply of dressings may be provided at one time, unless there is documentation to support the necessity of greater quantities in the home setting in an individual case.
Last Updated May 31, 2017