Refer to Attachment B for a list of items that do not meet the definition of DME or are excluded from coverage by Medicare.
The following HCPCS have been added to the policy:
E0447: Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (lpm)
E0467: Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions
T4545: Incontinence product, disposable, penile wrap, each
This policy has been identified and updated for the CPT code update effective 01/01/2019.
The following HCPCS narratives have been revised in this policy:
FROM: Hot water bottle, ice cap or collar, heat and/or cold wrap, any type
TO: Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type
FROM: Water circulating cold pad with pump
TO: Fluid circulating cold pad with pump, any type
FROM: High frequency chest wall oscillation air-pulse generator system, (includes hoses and vest), each
TO: High frequency chest wall oscillation system, includes all accessories and supplies, each