CMS Reminder: Bill Correctly for Device Replacement Procedures
March 2018 ~
CMS has issued a notice reminding providers and billing staff of the required condition codes to be used when submitting claims for device replacement procedures resulting from a recall or premature failure.
In a September 2017 report, the Office of the Inspector General (OIG) determined that Medicare paid for many device replacement procedures incorrectly.
CMS is reminding providers and billing staff that hospitals are required to use condition codes 49 or 50 on claims for device replacement procedures resulting from a recall or premature failure (whether the device is provided at no cost or with a credit).
To ensure correct billing and avoid overpayment recoveries, CMS recommends the following resources:
- OIG Report: Shortcomings of Device Claims Data Complicate And Potentially Increase Medicare Costs for Recalled and Prematurely Failed Devices
- Medicare Claims Processing Manual, Chapter 3, section 100.8
- Medicare Claims Processing Manual, Chapter 4, section 61.3.5 and 61.3.6
Source(s): CMS; OIG Report; Medicare Claims Processing Manual, Chapter 3, section 100.8; Medicare Claims Processing Manual, Chapter 4, section 61.3.5 and 61.3.6;
