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Ostomy - JD DME

Ostomy

The Standard Written Order (SWO) requirements are in effect for dates of service January 1, 2020 and after.
Refer to the SWO page for the elements needed in this streamlined order.

Coverage

Ostomy Supplies Local Coverage Determination (LCD) and Policy Article [PDF]

Documentation

Clinician Letter - Continued Medical Necessity [PDF] - Clinician directed letter that reminds them that ongoing need for and use of DMEPOS item must be documented in patient's medical record
Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
Ostomy Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation

Tips

Topic	Details
AU Modifier	HCPCS A4450, A4452 and A5120 furnished in conjunction with ostomy supplies must be billed with AU modifier. Claims for tape and adhesive (A4450, A4452, A5120) that are billed without an AU modifier or with another modifier indicating coverage under a different policy will be rejected as missing information
Consolidated Billing	If beneficiary is in a covered 60-day home health care episode, ostomy supplies are not billable to DME MAC. Supplies must be provided by home health agency with payment included in home health prospective payment system (PPS)

Last Updated Tue, 13 Jul 2021 15:20:51 +0000