RETIRED - DIFs Usage for Enteral and Parenteral Nutrition and External Infusion Pumps - Revised - JA DME
RETIRED - DIFs Usage for Enteral and Parenteral Nutrition and External Infusion Pumps - Revised
IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.
Content Provided on this page contains outdated information and instruction and should not be considered current.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 This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.
Joint DME MAC Publication
This article was originally published in January 2015 and is revised to reflect that external infusion pumps do not require a recertification DIF when the length of need expires and the ordering physician extends the length of need. A revised DIF is the proper form for the supplier to complete.
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:
- An enteral formula billed with a different code, which has not been previously certified, is ordered; or,
- For either enteral formulas or administration via pump (B9000 or 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).
- A beneficiary receiving enteral nutrition by the syringe or gravity method is changed to administration using a pump* (B9000 or B9002).
*Change in method of administration from gravity or syringe to a pump (B9000 or 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:
| Category | Reason |
|---|---|
| External Infusion | Changes in the existing drug HCPCS code |
| 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 Parenteral Nutrition | Change in HCPCS code for the current nutrient provided |
| 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) |
Recertification DIF:
A Recertification DIF is required for parenteral and enteral pump (only) 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 or Parenteral Nutrition can be located on each DME MAC website.
For additional information, refer to the Supplier Manual, the applicable Local Coverage Determination, and related Policy Article.
