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Special requirements for billing urology supplies & updated DMEPOS fee schedule

Source: The Bottom Line

Medicare covers urinary catheters and external urinary collection devices when they are used to drain or collect urine for a resident with permanent urinary incontinence or permanent urinary retention. According to CMS, permanent urinary retention occurs when the condition is not expected to be medically or surgically corrected within three months. The urology benefit under Medicare Part B does not cover the treatment of chronic urinary tract infection or other bladder conditions if the permanence requirement is not met.

Urology supplies are subject to the annual Part B deductible and the 20% coinsurance payment. The payments are made based on the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule. CMS announced the CY2019 updated DMEPOS fee schedule in an MLN article, effective January 1, 2019. Click here to view the article or copy and paste this URL into your browser: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11064.pdf

To bill for urology supplies, track the following:

  • Name of the resident
  • Date of services
  • HCPCS codes to identify the supplies used
  • Number of units
  • ICD codes for supplies provided (specific to permanent urinary retention or permanent incontinence)

Special requirements for urology supplies

The physician order must include the type(s) of supplies ordered and the approximate quantity to be used. A new order will be necessary if the quantity of the supplies to be used increases or the type of supply changes.

Documentation is required if a specialty indwelling catheter or silicone catheter is used instead of a straight Foley-type catheter. A three-way indwelling catheter, used alone or with other components, will be covered only if continuous catheter irrigation is medically necessary.

Leg bags are covered for beneficiaries who are ambulatory or wheelchair- or chair-bound. Leg bags for bedbound beneficiaries are not deemed medically necessary.

Be sure to review the coding guidelines when billing for multiple codes. Claims could be rejected if the HCPCS code used is a component of another code. The local coverage determinations include the codes that cannot be billed at the same time.