1. marilyn cadiz
   Posted 10 months ago #
   

   Help! Does anybody know how to bill "Medicare" and "Non-Medicare" for Tens Unit Muscle Stimulator?

2. SuperCoder
   Posted 10 months ago #
   

   64550 Application of surface (transcutaneous) (Neurostimulator)

   G0283 Electrical Stimulation (unattended) to one or more areas for indications other than wound care, as part of a therapy plan of care...billable to Medicare.

   97014 Application of modality; electrical stimulation (unattended) ... Not valid for Medicare use

   97032 Application of a modality one or more areas; Constant attendance electrical stimulation (each 15 minutes)... Not valid for Medicare use
   *******************************
   Payment Guidelines:
   During the rental of a TENS unit, supplies for the unit are included in the rental allowance; there is no additional allowance for electrodes, lead wires, batteries, etc. If a TENS unit (E0720 or E0730) is purchased, the allowance includes lead wires and one month's supply of electrodes, conductive paste or gel (if needed), and batteries.
   ...
   Separate allowance will be made for replacement supplies when they are medically necessary and are used with a TENS unit that has been purchased and/or approved by Medicare. If two (2) TENS leads are medically necessary, then a maximum of one unit of Code A4595 would be allowed per month; if four (4) TENS leads are necessary, a maximum of two units per month would be allowed. If the use of the TENS unit is less than daily, the frequency of billing for the TENS supply code should be reduced proportionally.
   ...
   There should be no billing and there will be no separate allowance for replacement electrodes (A4556), conductive paste or gel (A4558), replacement batteries (A4630), or a battery charger used with a TENS unit.
   ...
   Replacement of lead wires (A4557) will be covered when they are inoperative due to damage and the TENS unit is still medically necessary. Replacement more often than every 12 months would rarely be medically necessary.
   ...
   Other supplies, including but not limited to the following, will not be separately allowed: adapters (snap, banana, alligator, tab, button, clip), belt clips, adhesive remover, additional connecting cable for lead wires, carrying pouches, or covers.
   ...
   Applicable CPT Code
   64550 Application of surface (transcutaneous) neurostimulator
   ...
   Applicable HCPCS Codes
   E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation
   E0730 Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, larger area/multiple nerve stimulation
   E0731 Form fitting conductive garment for delivery of TENS or NMES (with conductive fibers separated from the patient’s skin by layers of fabric)
   E0762 Transcutaneous electrical joint stimulation device system, includes all accessories

3. marilyn cadiz
   Posted 10 months ago #
   

   Family Physician office bought unit on June 20, 2011. Are there any modifiers needed to append when billing?

4. SuperCoder
   Posted 10 months ago #
   

   EY - No physician or other licensed health care provider order for this item or service
   GA – Waiver of liability statement on file
   GZ – Item or service expected to be denied as not reasonable and necessary
   KX - Requirements specified in the medical policy have been met
   ...
   Reference:http://www.medicarenhic.com/dme/medical_review/mr_lcds/mr_lcd_current/L11506_2009-12-01_PA_2009-12.pdf

5. marilyn cadiz
   Posted 10 months ago #
   

   Never billed DME and now the phycician is asking if the EMS/Tens unit has to be billed as DME?

6. SuperCoder
   Posted 10 months ago #
   

   I have already mentioned the details in the payment guidelines regarding this. If by any of the above payment guidelines, you can bill DME as appropriate.

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