Billing for Denial of Items Previously Listed in the Home Dialysis Equipment and Supplies LCD for Non-ESRD Beneficiaries

Posted February 11, 2011

DME MAC A has received an increase in inquiries on the proper billing for denial of DME and supplies that were included in the retired Home Dialysis Equipment and Supplies LCD. Refer to the "Home Dialysis and Epoetin - Medical Policies Retired" Bulletin for additional details on the LCD retirement.

Many of the items included in the retired Home Dialysis LCD may also be used for beneficiaries whom are not on ESRD. (i.e. blood pressure monitors, sterile gloves, alcohol wipes, etc.) For Non-ESRD beneficiaries, these items are statutorily excluded. Therefore, in order to obtain a denial for a secondary insurer, these items and supplies must be billed with a GY modifier appended. The narrative field should also include an explanation of the reason for the GY modifier usage. (i.e. "Item is Non-Covered for Non-ESRD Beneficiary") This should produce a non-covered denial as opposed to an incorrect contractor denial.

The GY modifier should not be used for dialysis supplies provided to a beneficiary with ESRD. Those claims must be submitted to the A/B MAC Contractor.

            Last Updated Thu, 08 Jun 2017 14:29:53 +0000