Article Detail - JD DME
Billing Drugs or Supplies When the External Infusion Pump (EIP) is Beneficiary-Owned
Suppliers must ensure that beneficiary-owned equipment information is on file with Medicare Fee-for-Service (FFS) to avoid denials. Additional documentation to support medical necessity is required for supplies and accessories when the base equipment, such as a pump, has been provided and was not initially paid for by Medicare FFS.
Claims submitted for drugs and supplies used with beneficiary-owned equipment require three elements as listed below.
- Healthcare Common Procedure Coding System (HCPCS) code of base equipment (pump); and
- A notation that the pump is beneficiary-owned; and
- Approximate date the beneficiary obtained the pump
Example narrative for EIP supplies for a beneficiary owned pump:
BENEFICIARY OWNED K0455 PURCHASED MARCH 2016
Refer to the Drugs Used With External Infusion Pumps - Coverage and Billing Reminders for additional information on billing for drugs used with external infusion pumps.
Last Updated Wed, 30 Mar 2022 19:03:11 +0000