Article Detail - JD DME

Original Effective Date: 08/11/2003           
Revision Effective Date: 11/01/2013

Effective October 1, 2003:

 Claim lines for tape having more than one of the required modifiers AU, AV, AW, or AX will be returned as unprocessable or denied for incorrect coding. To avoid this, when providing tape to be used for purposes covered under multiple medical policies, bill only one modifier per claim line. For example, units of tape provided for use as a urological must be billed on one claim line with modifier AU; additional units of tape provided for use with surgical dressings must be billed on a separate claim line with modifier AW, even if the HCPCS code is the same.

Currently In Effect:

Conversely, if more than one claim line is billed having the same tape code, modifier, and date of service, the additional lines will deny as duplicates. Instead, combine and bill these units on one claim line. For example, the AU modifier represents tape used as a urological, ostomy, and/or tracheostomy supply. Therefore, if units of tape described by the same HCPCS code are dispensed on the same day for more than one of these purposes, add the number of units provided and bill them on one claim line with modifier AU.

Claims for tape dispensed on or after January 1, 2003 are adjudicated based on the presence of one of these modifiers and whether other information on the claim indicates the requirements of the applicable local medical review policy (LMRP) are met. Claims submitted without the coverage and/or medical necessity information required by the LMRP are denied accordingly.

For more information on modifiers AU, AV, and AW see the Winter 2003 DMERC Dialogue article entitled "New Modifiers – AU, AV, AW" on page 19. Tape (codes A4450 and A4452 only) supplied in conjunction with dialysis services is also covered and must have the modifier AX added. See the Winter 2003 DMERC Dialogue article entitled "New Modifier – AX" on page 18 for more information on use of the AX modifier.