Correct Coding and Coverage - RELiZORB® (Alcresta Therapeutics) In-Line Cartridge

DME MAC Joint Publication

Effective for claims with dates of service on or after January 1, 2019, the following code must be used for the RELiZORB® in-line cartridge:

  • B4105 IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH

Suppliers are reminded that the following dates of service (DOS) apply to billing of In-Line Cartridges for enteral feeding:

Effective for dates of service on or after July 1, 2018 through July 12, 2018, code Q9994 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH) is the code used to bill for in-line digestive enzyme cartridges. For these dates of service, code Q9994 is not payable by Medicare.

Effective for dates of service on or after July 13, 2018 through December 2, 2018, code Q9994 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH) is the code used to bill for in-line digestive enzyme cartridges. For these dates of service, code Q9994 is not separately billable and is included in the supply allowance for enteral feeding supplies (see section 30.7.2 of the Medicare Claim Processing Manual (Internet Only Manual (IOM) 100-4), Chapter 20, "Payment for Parenteral and Enteral Nutrition (PEN) Items and Services.")

Effective for dates of service on or after December 3, 2018 through December 31, 2018, claims for code Q9994 are eligible for separate payment.

Effective for dates of service on or after January 1, 2019, code Q9994 is crosswalked to code B4105 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH).  Claims for code B4105 are eligible for separate payment.

For codes Q9994 or B4105, suppliers are reminded that the beneficiary's medical record must document that the beneficiary that meets the Prosthetic Device benefit and supports the need for code Q9994/B4105. Suppliers must provide this information to the DME MACs, upon request.  

This information will be added to a future revision of the Enteral Nutrition LCD-related Policy Article Coding Guidelines. Refer to the Enteral Nutrition LCD, LCD-related Policy Article, and Standard Documentation Requirements article for additional information about coverage, coding, and documentation.

For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor, or e-mail the PDAC by completing the DME PDAC Contact Form available on the website https://www.dmepdac.com.

Publication History

Date of Change Description
07/27/18 Originally Published
01/10/19 Revised to include correct coding information based on date of service

 

Last Updated Jan 11, 2019