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IMPORTANT: Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

October 15, 2015

Completing an External Infusion Pump LCD DME Information Form (DIF) for Levodopa-Carbidopa Enteral Suspension - Billing Instructions

DME MAC Joint Publication

A DME Information Form (DIF) which has been completed, signed, and dated by the supplier, must be kept on file by the supplier and made available upon request. Recently, the Durable Medical Equipment Medicare Administrative Contractors (DME MAC) have received questions regarding the completion of the External Infusion Pump DIF (DME 09.03)PDF for Levodopa-Carbidopa enteral suspension (Duopa).

For claims with an initial date of service on or after November 15, 2015, suppliers must submit an INITIAL DIF in accordance with the instructions below. For beneficiaries who are currently receiving Duopa, the first claim submitted on or after after November 15, 2015 must include a REVISED DIF submitted in accordance with the instructions below.

DIF Questions #1 and #4

These questions require no special instructions, and should be completed as required.

DIF Question #2

Levodopa-Carbidopa enteral suspension is currently billed using HCPCS code J7799 (NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME). When a NOC drug code is billed for use with an external infusion pump, the name of the drug must be printed in response to question #2 on the DIF, and the claim must be accompanied by:

DIF Question #3

For the route of administration, the supplier must check option #4 - "Other" - as the answer to this question.

For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact FormExternal Website.

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