IMPORTANT – NEW PUMP CODE REPLACES THE NOC CODE BILLING FOR MEDICARE

• September 16, 2016
• Administrative, Clinical Practice Updates

Billing for the pump services rendered in the Part B setting are billed to PART B Medicare per the “Clarification” from CMS within MLN Matters, SE1609. CMS had “clarified” that prolonged drug and biological infusions using an external pump rendered IN THE PART B SETTING are billed to PART B MEDICARE and not the DME. This clarification affects both outpatient hospital and private practice. Most all Medicare MACs began requiring the billing under one “Not Otherwise Classified” code.

In an MLN Matters, CR9749, CMS released the Quarterly Update to the Medicare Physician Fee Schedule Database – October CY 2016 Update which included a NEW code for billing of these pump services (below). This code is effective retroactively to January 1, 2016, however, IT WILL NOT BE LOADED INTO THE SYSTEM AND AVAILABLE TO BILL UNTIL October 3, 2016.

Because billing the NOC requires documentation submission and delayed claims, many providers have decided to hold their claims for the PUMP ONLY until October 3rd and submit once the new code is in the system

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Bottom of page 2 of the MM9749.