Novitas Solutions Inc., the Medicare Administrative Contractor (MAC) A and B contractor for regions J-H and J-L on 06/25/2020 revised the Local Coverage Article (LCA): Billing and Coding: Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (A54117).
Main LCA Changes:
For dates of service on and after 07/01/2020:
- Group 2 paragraph and codes have been deleted as Q codes representing skin substitutes, are covered when administered and consistent with the related LCD and billed with application codes.
- A note was added to the text to indicate HCPCS codes Q4177, Floweramnioflo, 0.1 cc and Q4206, Fluid flow or fluid gf, 1 cc, are exceptions and do not require an application code.
- HCPCS codes Q4177 and Q4206 are retroactively covered for all dates of service when not billed with application codes 15271-15278.
Why is it important to track policy changes?
- The billing and documentation guidelines for your product are presented in the LCDs and the associated Articles and tracking their changes will help you assess billing, coding, or coverage impact on your Products.
- Providers rely heavily on payer policies for billing guidelines and coverage.
- Providers need to be educated on the documentation guidelines to reduce delays in payment.
- It helps to track competitor Products entering the market as competitor products and their coding and billing guidelines are mentioned in coverage policies
Why Partner with GIRS?
The GIRS Payer Advocacy Compass PAC® team has over 17 years of experience tracking payer policies and educating providers and stakeholders about changes to the policies to ensure coverage and reimbursement of our client’s medical technologies. Our work has enabled our clients to
- Analyze the impact of payer policy changes for our clients’ Products;
- comment on policy changes on time;
- correct mistakes in payer policies;
- clarify policy language for accounts;
- educate the sales force and accounts in new payer policy language;
- lay the foundation of customized payer advocacy strategies based on policy changes.
Please contact us at info@girsinc.com or avail of our Complimentary Review of your reimbursement needs at girsinc.com
Source: https://go.cms.gov/2D9yFZp
About GIRS
For more than 17 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, Email us at info@girsinc.com or call us at 901-834-9119.