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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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December 29, 2023

Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Claims

Effective on January 1, 2024, period of care claims with "Through" dates on or after this date, the billing and separate payment of an applicable disposable negative pressure wound therapy (NPWT) device shall be billed/paid on the period of care claim, Type of Bill (TOB) 032x. Medicare Administrative Contractors will also apply deductible, and coinsurance amounts to the payments. Make sure your billing staff is aware of these changes in billing/payment.

HHAs will submit their period of care claims with an applicable disposable NPWT device using the additional coding below.

Claim Field	Code	Description
TOB	032X	4th Digit - Definition 9 - Final Claim for an HH PPS Period 7 - Replacement of Prior Claim
Revenue Code	027x (other than 0274)	Medical/Surgical Supplies
HCPCS	A9272	Wound suction, disposable, includes dressing, all accessories and components, any type, each.
Service Date	Any date within the billing period is acceptable. The HHA may enter the date the device was applied or if there were more than one device applied during the period, the HHA may enter the date the first date the device was applied.	Required
Units	Represent the number of disposable devices provided during the billing period	Representing the number of disposable devices provided during the billing period
Charges	Report charges per the HHA's internal policy for determining charges	Required

Separate payment amount for applicable devices an HHA provides on or after January 1, 2024, would no longer include payment for nursing or therapy services described in Section 1861(m) of the Social Security Act (the Act). Payment for such nursing or therapy services would now be made under the Home Health Prospective Payment System (HH PPS) and is no longer separately billable. Since Medicare payment no longer includes the services of the practitioner applying the device, revenue codes 042x, 043x or 0559 are not used for disposable NPWT HCPCS codes on Type of Bill 032x.

Before CY 2024, under the home health benefit, Medicare made a separate payment for providing negative pressure wound therapy (NPWT) using a disposable device on a TOB 034x containing CPT codes 97607 or 97608, as directed in section 90.3 of Chapter 10 - Home Health Agency Billing. That payment was for both the device and the services related to applying the device. Don't submit claims with a date of service on or after January 1, 2024, for an applicable disposable NPWT device on TOB 034x. Medicare will return claims on TOB 034x containing CPT codes 97607 or 97608 for a date of service on or after January 1, 2024.

References:

MLN Matters Number: MM13244
Medicare Claims Processing Manual, Chapter 10 - Home Health Agency Billing

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Separate Payment for Disposable Negative Pressure Wound Therapy Devices on Home Health Claims

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