Parenteral and Enteral Nutrition Therapy - JA DME
Parenteral/Enteral Nutrition (PEN) Therapy
Parenteral/Enteral Pump Rental/Purchase
Parenteral/enteral pumps are in their own DMEPOS Payment Category and are limited to payments for a total of 15 months during a period of medical need. Payment policies for these pumps generally follow the rules for capped rental items.
Additional rental payments after the 15-month limit have been reached or after the pump has been purchased will only be considered if the attending physician changes the prescription between parenteral and enteral nutrients.
A change in suppliers during the 15-month rental period does not begin a new 15-month rental period. The new supplier is entitled to the balance remaining on the 15-month rental period. The supplier that collects the last month of rental (i.e., the 15th month) is responsible for ensuring that the beneficiary has a pump for as long as it is medically necessary and for maintenance and servicing of the pump during the period of medical necessity.
The beneficiary has the option of purchasing or renting the pump from the supplier. DME MACs must request written authorization from the beneficiary before or after paying for a pump purchase. If the beneficiary decides to purchase the pump once rentals have been paid, the purchase allowance will consist of the used purchase allowance less the amount allowed to date for rentals.
Medicare will consider payment for either a replacement by purchase or 15 months of rental for parenteral/enteral pumps purchased more than eight years prior to the current date.
Maintenance and Servicing
Necessary maintenance and servicing of parenteral/enteral pumps after the 15-month rental limit is reached may include repairs and extensive maintenance that involve the breaking down of sealed components, or performing tests that require specialized testing equipment not available to the beneficiary or nursing home. Payment will only be made for actual incidents of maintenance, servicing or replacement. The DME MAC may request written proof from the supplier of maintenance and servicing of the pump.
For enteral pumps, no more than one-half rental payment may be paid every six months, beginning six months after the last rental payment. For parenteral pumps, no more than one-half the rental payment may be paid every three months, beginning three months after the last rental payment for the pump. Claims for replacement of parenteral/enteral pumps purchased more than eight years ago will be considered for payment.
The modifier used in this category is MS (Maintenance and servicing)
