External Infusion Pumps (HCPCS E0781 and E0784) Notification of Documentation Compliance Review

Noridian Jurisdiction D, DME MAC, Medical Review will be initiating a documentation compliance review of the following HCPCS code(s):

E0781: AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANNELS, ELECTRIC OR BATTERY OPERATED, WITH ADMINISTRATIVE EQUIPMENT, WORN BY PATIENT

E0784: EXTERNAL AMBULATORY INFUSION PUMP, INSULIN

A documentation compliance review is a nonclinical, technical review verifying that submitted documentation meets payment requirements according to Local Coverage Determinations (LCD) for that DMEPOS item. This review is being initiated based on the complex medical review results.

In order to evaluate compliance with Medicare coverage and coding rules, all suppliers billing Jurisdiction D for HCPCS codes listed above are subject to this review. Suppliers of the selected claims will receive an Additional Documentation Request (ADR) letter asking for the following specific information to determine if the item billed complies with the existing reasonable and necessary criteria:

  • Treating physician's dispensing and written order
  • Dispending order (if applicable)
  • The most recent DME Information Form (DIF)
  • Proof of delivery
  • The Advanced Beneficiary Notice (if applicable)
  • Any other supporting documentation

Failure to supply the above requested information within 45 days of the date on the letter will result in the claim being denied. Please fax or mail the requested documentation and a copy of the ADR letter. The ADR letter provided will also provide instruction for submitting documentation.

It is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the External Infusion Pumps Local Coverage Determination (LCD) L11570 and Policy Article A19834.

Additional information, educational opportunities and training tools related to this product category are available on our Education and Outreach page.

Information about prepay reviews may be found in CMS Internet Only Manual (IOM), Medicare Program Integrity Manual, Publication 100-8, Chapter 3.

Last Updated Fri, 17 Apr 2015 03:22:47 +0000