IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

DME MAC Joint Publication

Post July 27, 2018

Effective for dates of service on or after July 13, 2018, the Medicare coverage indicator administrative field has been changed for code Q9994. Healthcare Common Procedure Coding System (HCPCS) code Q9994 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH) was added to the Level II HCPCS code set effective July 1, 2018. This code describes products used in the administration of enteral nutrients. When new HCPCS codes are created, Medicare adds "administrative fields" to each HCPCS code to provide information necessary for claim processing by contractors.

The original administrative field for the coverage indicator was "I" which means "not payable by Medicare" for a claim to Medicare. The coverage indicator is being changed to "D" which means "special coverage instructions apply." The coverage instructions arise from section 30.7.2 of the Medicare Claim Processing Manual (Internet Only Manual (IOM) 100-4), Chapter 20, "Payment for Parenteral and Enteral Nutrition (PEN) Items and Services."

All existing Medicare coverage and payment rules, including the rules under section 30.7.2, continue to apply, and neither the code nor indicator change those rules. This change is effective for dates of service on or after July 13, 2018, and until further notice.

Refer to the Enteral Nutrition LCD, LCD-related Policy Article, and Standard Documentation Requirements article for additional information about coverage, coding, and documentation.

For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form available on the website

Publication History

Date of Change Description
07/27/18 Original publication
01/10/19 Retired - See revision published on 01/10/19


Last Updated Thu, 10 Jan 2019 12:17:19 +0000