Commercial

Waiver of certain requirements during COVID-19 outbreak related to Durable Medical Equipment (DME), prosthetics, orthotics, and supplies (Updated April 16, 2021)​



Policies Impacted

00.01.25bc​ PPO Network Rules for Provision of Specialty Services for Durable Medic​al Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services​​

05.00.81 Osteogenic Stimulators​​ (non-invasive, invasive/semi-invasive, electrical and ultrasound ​sound)​

05.00.01m Pneumatic Compression Therapy Devices

05.00.09i   Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System​

05.00.12h  Manual Wheelchair​s

05.00.14l​ High-Frequency Chest Wall Oscillation Devices​

05.00.15r Nebulizers ​and Inhalation Solutions

05.00.21x Durable M​ed​ical Equipment (DME) and Consumable Medical Supplies​

05.00.24r ​Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)​

05.00.29l Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)

05.00.30m Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices (Independence Administrators)

05.00.32j Speech and Non-Speech Generating Devices


05.00.38k Negative-Pressure Wound Therapy (NPWT) Systems

05.00.39q​  Ankle-Foot/Kn​ee-Ankle-Foot Orthoses

05.00.42h  ​Patient Lifts​

05.00.43g Seat Lift Mechanisms​

05.00.47o Knee Orthoses​

05.00.54h     Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Ac​tivated Power-Assist Devices​

05.00.55i Wheelchair Cu​shions and Seating​

05.00.56j     Hospital Beds​ and Accessories​

05.00.58m Home Oxygen Therapy

05.00.59j Lower Limb Prostheses

05.00.60i     Pressure Redu​cing Support Surfaces​

05.00.61g     Cervical Traction Devices for In-home Use​

05.00.67q    Wheel​chair Options and Accessories​

05.00.73d     Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)

05.00.74e     Transcutaneous Electrical Stimulators (TENS) and Associated Supplies

07.03.05x Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies (Independence)

11.00.06k Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring

11.15.03k Implantable Inf​usion Pumps​



Purpose

The purpose of this News Article is to provide advance notice regarding the temporary waiver of certain requirements for Durable Medical Equipment (DME), as well as prosthetics, orthotics, and supplies in response to Coronavirus Disease 2019 (COVID-19).

This communication addressing DME, prosthetics, orthotics, and supplies is effective from March 6, 2020 and will be reevaluated for continuing applicability on June 30, 2021. ​



Background

There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has now been detected both nationally and internationally. The virus has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (COVID-19). The SARS-CoV-2 virus has demonstrated the capability to rapidly spread, leading to significant impacts on healthcare systems and causing societal disruption. The potential public health threat posed by COVID-19 is high globally. To effectively respond to the COVID-19 outbreak, rapid detection of cases and contacts, appropriate clinical management and infection control, and implementation of community mitigation efforts are critical.

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Indications

N/A



Coverage Statement

During this COVID-19 outbreak, the Company is waiving signature and proof of delivery requirements for Durable Medical Equipment (DME) when a signature cannot be obtained because of the inability to collect signatures. Suppliers should document in the medical record the appropriate date of delivery and that a signature was not able to be obtained because of COVID-19.

During the COVID-19 outbreak, certain DME, as well as prosthetics, orthotics, and supplies replacement requirements (i.e. face-to-face requirement, a new professional provider order, and a new medical necessity documentation) may be waived when an item is lost, destroyed, irreparably damaged, or otherwise rendered unusable. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DME, prosthetics, orthotics, and supplies were lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency.

"Durable Medical Equipment (DME), prosthetics, orthotics, and supplies" are addressed in the current versions of the following policy bulletins:

00.01.25PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
05.00.14High-Frequency Chest Wall Oscillation Devices
05.00.01Pneumatic Compression Therapy Devices
05.00.09Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System
05.00.12Manual Wheelchair
05.00.15Nebulizers and Inhalation Solutions
05.00.21Durable Medical Equipment (DME) and Consumable Medical Supplies
05.00.24Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)
05.00.29Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
05.00.30Noninvasive Respiratory Assist Devices (RADs) (eg, CPAP, Bi-PAP)
05.00.32Speech and Non-Speech Generating Devices
05.00.38Negative-Pressure Wound Therapy (NPWT) Systems
05.00.39Ankle-Foot/Knee-Ankle-Foot Orthoses
05.00.42Patient Lifts
05.00.43Seat Lift Mechanisms
05.00.47Knee Orthoses
05.00.54Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
05.00.55Wheelchair Cushions and Seating
05.00.56Hospital Beds and Accessories
05.00.58Home Oxygen Therapy
05.00.59Lower Limb Prostheses
05.00.60Pressure Reducing Support Surfaces
05.00.61Cervical Traction Devices for In-home Use
05.00.67Wheelchair Options and Accessories
05.00.73Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
05.00.74Transcutaneous Electrical Stimulators (TENS) and Associated Supplies
07.03.05Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
11.00.06Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring
11.15.03Implantable Infusion Pumps




Dosing and Administration

N/A



Black Box Warnings and/or Contraindications

N/A



Coding

N/A




5/7/2020