August 23, 2010
Billing for Denial of Vancomycin Administered Via an External Infusion Pump
National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has received questions regarding how to bill for denial of vancomycin being administered through an external infusion pump.
If the beneficiary does not meet the coverage criteria for the drug or if the drug being administered through the external infusion pump is not listed in the external infusion pump medical policy, the following will be denied as not medically necessary with ANSI denial reason code CO-50:
- the external infusion pump
- the drug and
- the external infusion pump supplies
When the beneficiary does not meet the coverage criteria or if the drug is not listed in the external infusion pump medical policy, suppliers must execute an Advance Beneficiary Notice of Noncoverage (ABN) for all items (drug, pump and supplies) associated with the administration of the drug if the supplier elects to hold the beneficiary financially liable. If suppliers have properly executed an ABN, the GA modifier should be appended to all claim lines. If suppliers did not properly execute an ABN, the GZ modifier should be appended to all claim lines.
Suppliers may obtain additional information regarding billing for denial of home infusion therapy to the DME MAC by simply logging on to the National Government Services Medicare University at www.MedicareUniversity.com. Once you have logged in select the course catalog from the left side menu options. Select the "Details "button for the course entitled "Billing Denials for Home Infusion Therapy" or look for the course catalog number DME-C-0026. Once you have located the computer based training course, you will need to enroll and then access your curriculum list and launch the Billing Denials for Home Infusion Therapy course.