Correct Coding - Modifiers AU AV and AW - JD DME

Joint DME MAC Publication

HCPCS modifiers have been established for use when items are furnished in conjunction with various supplies listed in multiple DME MAC Local Coverage Determinations (LCD) and related Policy Articles (PA). These modifiers are effective for dates of service (DOS) on or after January 1, 2003, and claims submitted without the appropriate modifiers are currently denied as non-covered. Effective for dates of service on or after August 1, 2015, claims submitted without the appropriate modifier will be rejected as missing information. The modifier narratives are:

• AU - Item furnished in conjunction with a urological, ostomy, or tracheostomy supply
• AV - Item furnished in conjunction with a prosthetic device, prosthetic or orthotic
• AW - Item furnished in conjunction with a surgical dressing

These modifiers identify items that are eligible for reimbursement under multiple benefit or payment categories. At this time, the only codes with which these modifiers may be used are:

• A4217 – Sterile water/saline, 500 ml
• A4450 – Tape, non-waterproof, per 18 square inches
• A4452 – Tape, waterproof, per 18 square inches
• A5120 – Skin barrier, wipes or swabs, each
• A6531 – Gradient compression stocking, below knee, 30-40 MMHG, each
• A6532 – Gradient compression stocking, below knee, 40-50 MMHG, each
• A6545 – Gradient compression stocking, wrap, non-elastic, below knee, 30-50 MM HG, each

For example, tape used with a facial prosthesis must be billed using the AV modifier. Tape used with an ostomy pouch must be billed with the AU modifier. Tape used with a surgical dressing must be billed using the AW modifier. The use of specific modifiers is addressed in each LCD and related PA in which these modifiers are applicable. Suppliers should consult the appropriate LCD and related PA for additional coverage, coding and documentation requirements.

These modifiers must not be used with any other HCPCS codes. Use of these modifiers with other codes will result in the return or rejection of the claim line(s) for incorrect modifier use.

Claims for codes A4217, A4450, A4452, A5120, A6531, A6532 and A6545 submitted without an AU, AV or AW modifier (as applicable) with dates of service on or after August 1, 2015, will rejected as missing information and must be resubmitted with the correct modifier applied.

Reference: ANWG 02.45; PM AB-02-152