Description
All Medical Supplies included in the Consolidated Billing List and billed during admission of a patient to Home Health services are inclusive to Home Health services.
Affected Code(s)
Consolidated Billing Master Supply List, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-payment/HomeHealthPPS/coding_billing.html - non-routine supply codes
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1833(e) - Payment of Benefits
2. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1834(a)(7)(C)(i), (ii) and (iii)- Replacement of Items
3. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1842(p)(4)- Provisions Relating to the Administration of Part B
4. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
5. 42 Code of Federal Regulations (CFR), §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 CFR §405.929- Post-Payment Review
7. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
8. 42 CFR §405.986- Good Cause for Reopening
9. 42 CFR §410.38- Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS): Scope and conditions
10. 42 CFR §414.210(f)- Payment for Replacement of Equipment
11. Medicare Claims Processing Manual, Ch. 20- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) §50- Payment for Replacement of Equipment; §110- General Billing Requirements - for DME, Prosthetics, Orthotic Devices, and Supplies; §212- Home Health Consolidated Billing and Supplies Provided by DMEPOS Suppliers
12. Medicare Benefit Policy Manual, Ch. 16- General Exclusions from Coverage, §180- Services Related to and Required as a Result of Services Which Are Not Covered Under Medicare
13. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
14. Medicare Benefit Policy Manual, Chapter 7 - Home Health Services, §40- Covered Services Under a Qualifying Home Health Plan of Care; §50- Coverage of Other Home Health Services
15. Medicare Claims Processing Manual, Chapter 10- Home Health Agency Billing, §20.2 - Home health Consolidated Billing Edits in Medicare Systems; Section §10.1.17- Payment Adjustments - Low Utilization Payment Adjustments (LUPAs)
16. CMS Consolidated Billing Master Supply List, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-payment/HomeHealthPPS/coding_billing.html
17. HCPCS Level II Codebook