RETIRED - DIF Usage for Enteral and Parenteral Nutrition and External Infusion Pumps - Revised - JA DME

Joint DME MAC Publication

Posting April 6, 2017

The DME MACs use DME Information Forms (DIF) when processing claims to assure the most current information is on file and to allow the claims to pay correctly. Claims for enteral and parenteral nutrition and external infusion pumps require a DIF to be submitted with the initial claim as well as when changes in the items or quantities provided are made. DIFs are completed entirely by the supplier and do not need to be signed by the treating physician. DIFs are required to be signed and dated by the supplier.

The following table indicates the DIFs for external infusion pumps and enteral/parenteral nutrition.

DME MAC FORM CMS FORM ITEMS ADDRESSED

09.03                          10125             External Infusion Pumps

10.03                          10126             Enteral and Parenteral Nutrition

Initial DIF:

A new Initial DIF is required when:

1. An enteral formula billed with a different code, which has not been previously certified, is ordered; or,
2. For either enteral formulas or administration via pump (B9002), there has been a break in billing of more than 60 days (plus the remaining days in the rental month) and there has been a change in the underlying medical condition that justifies coverage for the item(s).
3. A beneficiary receiving enteral nutrition by the syringe or gravity method is changed to administration using a pump* (B9002).

*Change in method of administration from gravity or syringe to a pump (B9002) requires a new initial DIF for the pump and a revised DIF for the enteral nutrient (See chart below).

Revised DIF :

A Revised DIF is required when there has been a change in any of the information recorded on the DIF. The table below lists changes that require a Revised DIF to be submitted:

External Infusion           Changes in the existing drug HCPCS code

Pumps

Substitution of drug HCPCS code for existing drug HCPCS code

Addition of drug HCPCS code

Change in the route of administration

Change in method of administration

Extend expired length of need

Enteral and                    Change in HCPCS code for the current nutrient provided

Parenteral Nutrition

Change (increase or decrease) in the calories prescribed

Change in the method of administration from gravity to syringe or syringe to gravity (See above for gravity or syringe to pump)

Change in the number of days per week of administration

Change in route of administration from tube feedings to oral feedings (if billing for denial)

When the length of need previously entered on the DIF has expired and the ordering physician is extending the length of need for the item(s)

The DIFs for External Infusion Pumps and Enteral Nutrition or Parenteral Nutrition can be located on each DME MAC web site.

For additional information, refer to the Supplier Manual, the applicable Local Coverage

Determination and related Policy Article, and the Standard Documentation Requirements Policy Article.

Revision History

Publication Date: April 2017

Revised: Clarifies that a Revised DIF instead of a Recertification DIF is required for Parenteral and Enteral Nutrition when the ordering physician extends length of need.

Deleted: HCPCS Code B9000, which was cross walked to HCPCS Code B9002

Publication Date: January 2017

Revised: Corrects a clerical error that at the end of the article, which inadvertently left the instructions for suppliers to obtain a recertification DIF for External Infusion Pumps when length of need expires and the ordering physician extends the length of need.

Publication Date: June 2015

Revised: A Revised DIF instead of a Recertification DIF is required for External Infusion Pumps when the ordering physician extends length of need.

Original Publication Date: January 2015

Publication History