Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - July 23, 2025

Attendees

Members: Anna Markiewicz, Barb Stockert; Bill Noyes, Buffy Nelson, Carolyn Koester, Februari Lester, Heather Werner, Jan Palmer, Kimberly Hanson, Kristine Cram, Maria Koehnlein, Marsha Lawrence, Melinda Eberhart, Michelle Wullstein, Noel Neil

Noridian: Amber Mertz, Amy Walter, Corinne Medina, Emily Murch, Gina Ahlf, Jennifer Lund, Julie Dallmann, Kate Petersen, Michele Gerlach, Shelly Carlson, Tanya Gillies, Tracy Schutt, Travis McDonald

POEAG Mission and Goals

Mission

To determine the best methods of providing quality education and training to our supplier community.

Goals

  • The primary function of the POEAG is to help the MAC create, implement, and review provider education strategies and efforts.
  • The POEAG provides input and feedback on training topics, provider education materials, and dates and locations of provider education workshops and events.
  • The POEAG also identifies salient supplier education issues and recommends effective ways to disseminate information to all appropriate suppliers and their staff.
  • The POEAG is a provider education consultant resource but not an approval or sanctioning authority.

Suggestions from POE Advisory Members

  • Realigning with IOM direction
  • Bring suggestions and feedback to this meeting
    • Policy specific questions:
      • Ask the Contractor Meeting (ACM) - August 20, 2025
      • Monday Live Chat
      • Policy specific webinars

Standing Items

  • Collaborative MAC education
    • A/B DME Workgroup - Wheelchair Options and Accessories
      • September 30, 2025
    • CERT Task Force Enteral/Parenteral Nutrition webinar
      • TBD

Follow-up from Previous Meeting - General

  • Supplier complaints due to differences between CGS/Noridian processes
    • None currently
  • There is a new code, E0469 (lung expansion airway clearance, continuous high frequency oscillation, and nebulization device) with no policy. Can education be provided to suppliers on what to do if there is not a policy for the item they are providing?
    • For items that are covered by Medicare and do not have a policy, suppliers should follow the Standard Documentation Requirements Policy Article A55426.
  • Regarding the new codes for hydrophilic intermittent urinary catheters, will there be education for DME suppliers and clinicians?
    • The DME MACs have not received instruction from CMS yet. We will provide education when it becomes available.
    • The PDAC website has additional information on the applicable HCPCS codes.

Joint DME MAC Publications posted at Policies > Medical Director Articles > 2025

  • Posted April 17, 2025 - Documentation created by orthotists and prosthetists shall be considered part of the medical record to support documentation created by the treating practitioner
  • Posted May 8, 2025 - Lymphedema Compression Treatment Items - Correct Coding and Billing - Revised
  • Posted May 22, 2025 - New HCPCS Codes for Wheelchair Transportation/Transit Securement Systems - Correct Coding - Revised
  • Posted May 22, 2025 - Clarification on the use of the JZ and JW modifiers for external infusion pumps
  • Posted May 29, 2025 - The information in the LCDs and related policy articles supersedes the Standard Documentation Requirements for All Claims.
  • Posted June 5, 2025 - Upper Extremity Prosthetic Myoelectronic Control - Correct Coding and Code Verification Review Requirement

New Items

General

  • Virtual Events
    • Big Sky - August 14, 2025
    • AADSM - November 15, 2025
  • Ask the Contractor Meeting (ACM)
    • August 20, 2025
    • General - all topics
  • Effective June 1, 2025, Supplier Contact Center can only accept three inquiries for the same NPI/PTAN combination per call
    • All provider combinations must first be authenticated through the Interactive Voice Response (IVR) system
  • For dates of service on or after October 17, 2024, claims for Vyalev must be submitted using HCPCS J7799. Must include the following narrative on each claim:
    • Name of drug
    • Manufacturer name
    • Dosage strength
  • For dates of service before January 24, 2025, claims for Vyafuser pump and administration supplies must be coded as E1399 for the pump and A9999 for administration supplies. Use code E1399 if a unique pump is FDA approved and does not fall under existing pump HCPCS code. Must include the following narrative each claim:
    • Description of the item
    • Manufacturer name
    • Product name and number
    • Supplier price list
    • HCPCS of related item
  • Urological supplies frequently asked questions (FAQs)
    • Noridian Medicare website > Browse by DMEPOS Category > Urological Supplies
  • Prior authorization requests for bilateral orthoses can be submitted on the same request
    • Specify in order by indicating quantity of two, specifying right and left side, or through medical record
      • When submitting for prior authorization, will receive two unique tracking numbers (UTNs)
        • Exception - must submit separate prior authorization request for mirror codes
  • CMS released final National Coverage Determination (NCD) and decision memo

DME

  • New Noridian HIV PrEP static page
    • Noridian Medicare website > Browse by DMEPOS Category > Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis (PrEP) Drugs
  • CMS has updated the resource for PrEP for HIV & Related Preventive Services
    • New code effective Jan 1, 2025 - Q0521 (supply fee HIV PrEP)
      • First dispensed pay $24 (initial supply in a 30-day period or $16 (additional supply in the same 30-day period
    • Discontinue billing pharmacy fee for HCPCS Q0516, Q0517, Q0518, Q0519, Q0520
  • External Infusion Pumps tool updated and renamed
    • Oral and Infusion Drugs Tool
    • Scope expanded to include oral anticancer drugs, oral immunosuppressive drugs, IVIG and EIP drugs
  • Realigning with IOM
    • Policy specific questions
      • ACM on August 20, 2025
      • Monday Live Chat (MLC)
      • Policy specific webinars

Open Discussion/Additional Member Comments/Suggestion

  • Regarding the hydrophilic intermittent urinary catheters, the DME Medical Directors (DMDs) published a good resource on July 17 titled Documentation Requirements for New Urological Supply Codes. Can this also be shared with the group? It clarifies Standard Written Order (SWO) requirements when billing these new codes.
    • Noridian Medicare website > Latest Updates > Documentation Requirements for New Urological Supply Codes
  • Have there been any updates on the home mechanical ventilator (HMV) policy? Our industry has posed many questions to CMS, but we haven't received a formal response. Has Noridian heard of any changes to the RAD HMV policies?
    • Noridian is waiting for direction from CMS.
  • There has been billing and coding guidance for Vyalev released since this presentation. Was this a matter of timing?
    • Yes, we apologize for this. The most recent publication is titled "VYALEV (foscarbidopa and foslevodopa), the VYAFUSER Pump, and Related Infusion Supplies - Correct Coding and Billing - Revised." This is found on the Noridian Medicare website > Browse by DMEPOS Category > External Infusion Pump > Related Articles section.
  • Has there been information released on grandfathering HMVs?
    • Noridian has not heard anything regarding this.
  • Information was published on items not covered regarding HCPCS code E0469. If the beneficiary has an E0570 (nebulizer, with compressor), E0482 (cough stimulating device), and/or E0483 (high frequency chest wall oscillation device) on file within the past five years, and we bill the E0469, will this deny for same or similar?
    • This should not deny as same or similar against the E0570, E0482 and/or E0483. However, if there is an appealable denial, suppliers should send to appeals with documentation to support medical necessity for the E0469.
  • Thank you for publishing the Pneumatic Compression Devices - Dates of Service On or After November 14, 2024, documentation checklist per the POEAG's request. Also, the Noridian website is easy to navigate and search; it is appreciated.
    • Thank you for the feedback, we appreciate hearing this.

Upcoming Meeting

Next Meeting: October 22, 2025

Last Updated Aug 01 , 2025