[Cuda]

I've received several phone calls from suppliers that say their manufacturer's reps are telling them that CMS is deleting heat therapy pumps and pads at the end of this month. I haven't found anything official from CMS. Has anyone else heard this? (trying to seperate fact from fiction)
Thanks in advance!

[Sleeping410]

Yes, that code is being eliminated effective April 1st. Adroit Medical has started the process with CMS to reinstate that code or cover it under another code. Seems Medicare pulled out the hatchet when a good scalpel would have done the job.

[AndreaStark]

A detailed article on the New Heathing Pad LCD that covers this was previously published in Andrea Stark's February issue of Vista Notes.

(Andrea is a DME consultant at MiraVista LLC (www.miravistallc.com). Vista Notes is a bi-monthtly newsletter she releases to keep suppliers up to date on the latest Medicare billing and reimbursement changes.)

I've pasted a copy of the full article below.

New Heating Pad LCD to be Effective April 2011ffice:office" />
By: Andrea Stark, DME Consultant, MiraVista LLC
(as published in Vista Notes, February 2011)

After 3 long years of relative silence on this issue, CMS is finally ready to release a final version of their Heating Pads and Heat Lamps LCD. The latest revision to the draft includes an effective date of April 1, 2011, and concerns about the elimination of coverage for the popular water circulating heat pads have been affirmed..

According to the future LCD, only standard electric heating pads (E0210) will be covered by Medicare. CMS has deemed the following items as noncovered: hydrocollator units (E0225, E0239), nonelectric heating pads or wraps (A9273), moist electric heating pads (E0215), water circulating heating pads (E0217), and heating lamps (E0200, E0205). Accessories billed with these products such as the pump (E0246) and pads (E0239 and A9999) will also be denied beginning with services on or after 4/1/2011.

An E0210 is defined as “a flexible device containing electric resistive elements producing heat.” It must have a fabric cover and a timing device for automatic shut-off. If the device contains heat retaining material (e.g. gel), “the material must be contained in an enclosed pouch or bag in or around the heating elements.” All heating pads must be certified by Underwriters Laboratories (UL Certified).

A heating pay may include a cover, or other element, that draws humidity from the air to create moisture and still be billable as an E0210. This is considered acceptable, as water is not being added directly to the device. If a device requires water to be added to it or another element/component, it is coded as an E0215 and is noncovered.

If there are any questions as to how a product is classified, you may contact the DME PDAC at 877-735-1326, or visit https://www.dmepdac.com/dmecsapp/do/search and conduct a product search to look up your vendor and model number.

The LCD does not provide specific coverage criteria for an E0210, beyond stating that the heating pad is covered when used to relieve certain types of pain (excluding pain related to peripheral neuropathy), joint and tissue stiffness, relax muscles or to reduce inflammation.

In terms of documentation, the physician must document the specific condition for which the heating pad is being used, alternative therapies that have been tried, and show that a physical examination of the patient was performed to diagnose treatment prior to ordering the heat therapy. The LCD does not provide specific criteria for the physical examination.

A response document that addresses concerns raised by those that would champion the cause of the water circulating heating pad is available at:http://apps.ngsmedicare.com/pdf/Heating%20PadsResponsetoCommentsDecember2010.pdf

If you continue to dispense the E0215 or E0217 products, you should execute an upgrade ABN. The patient must understand about the additional features offered by these products over a standard heating pad, and that there is an additional cost to the patient for the difference in submitted charges between the E0210 and the product the patient is selecting. This protocol requires that two line items be billed when submitting a claim: the more sophisticated model with the GA modifier, and the standard item with the GK modifier. As an alternative you may also choose to offer free upgrades to the patient for supplier convenience or inventory purposes (e.g. upgrade to a moist heating pad). This requires you to bill the standard item with the GL modifier and disclose in the narrative statement which item was actually provided in case an auditor takes issue with proper coding.

[AndreaStark]

For some reason the Vista Notes article on Heating Pads shows up fine on the thread, but is all smashed together below when I read it in my e-mail copy below.

For a clear article with correct spacing, please visit the thread directly:
E0217 going away?

Sorry. No clue why it formatted so messed up in the e-mailed version.

Sincerely,

Michelle Hamel
Communications Specialist, MiraVista LLC

michelle@miravistallc.com
803.462.9959 x 252 (Phone)
803.251.9006 (Secure FAX)

MiraVista LLC
DMEPOS Consulting & Reimbursement
www.miravistallc.com

For outsourced DME billing, visit ClaraVista, LLC.
www.claravistallc.com/billing.php
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