RETIRED - Respiratory Assist Devices - Continued Coverage

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current.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 This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Original Effective Date: 03/15/2002
Revision Effective Date: 11/01/2013

In the Respiratory Assist Devices local medical review policy, Coverage and Payment Rules section, Medicare Beneficiary Statement subsection, the last sentence will be revised by deleting the phrase "that the beneficiary has seen the treating physician within the month of statement completion and at least 61 days after initiating use of the machine." Though there continues to be a requirement for a separate physician statement completed no sooner than 61 days after initiation of the device which documents compliant use of the RAD, there is no requirement that there be an office visit and no requirement that the physician statement and beneficiary statement be completed in the same month.

The Documentation section of the policy specifies that on the fourth month's claim (and any month thereafter) the ZX modifier (KX after July 1, 2002) may not be added unless criteria for the physician's statement and beneficiary statement have been met. As an example, if use of a RAD is begun on 7/1 and if a qualifying physician statement is not obtained until 10/15 and a qualifying beneficiary statement is not obtained until 11/20, then if the claims for 10/1 and 11/1 (i.e., the fourth and fifth month's claims) are not submitted until on or after 11/20 (i.e., after both statements have been obtained), the ZX modifier may be added to the appropriate claim lines. However, if the 10/1 and 11/1 claims are submitted before 11/20, the ZX modifier may not be added. (The revised Respiratory Assist Devices LMRP is included in the accompanying supplier manual update.)


            Last Updated Thu, 10 Jan 2019 12:26:05 +0000