Clarification on Coverage Guidelines for HCPCS E0936
National Government Services, the Jurisdiction B DME MAC would like to remind suppliers of the Medicare coverage on Healthcare Common Procedure Coding System (HCPCS) code E0936 (Continuous passive motion (CPM) exercise device for use other than knee).
When Medicare coverage on a specific HCPCS code is unclear, suppliers are encouraged to review the HCPCS Code Listings that are available on the National Government Services Web site at: http://www.ngsmedicare.com/content.aspx?CatID=3&DOCID=192.
The listings are developed in order to assist suppliers with validation of coverage on the particular HCPCS codes. When reviewing the document, it is encouraged to reference the coverage column. Below is an example of how the HCPCS E0936 appears in the HCPCS code listings.
| HCPCS | Action Code | Long Description | Coverage | Code Add Date | Action Eff Date |
| E0936 | A | CONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE OTHER THAN KNEE | M | 20070101 | 20070101 |
The coverage indicator for HCPCS E0936 is an M . In order to determine what the coverage indicator M means, suppliers will need to access the Structure of HCPCS Codes page on the National Government Services Web site at: http://www.ngsmedicare.com/content.aspx?CatID=3&DOCID=193
Below is the chart that shows the indicators and their meanings.
| D | Special coverage instructions apply |
| I | Not payable by Medicare (no grace period) |
| G | Not payable by Medicare (90 day grace period) |
| M | Noncovered by Medicare |
| S | Noncovered by Medicare statute |
| C | Carrier judgment |
According to this chart, a coverage indicator of an M means that the HCPCS code is noncovered by Medicare. Therefore, HCPCS code E0936 is noncovered by Medicare.
If suppliers are dispensing a CPM device that is not used for the knee (E0936), they are not required to submit claims to Medicare on behalf of the beneficiary because the item is statutorily excluded from coverage. However, if the beneficiary (or his/her representative) believes that the item/service could potentially be covered by Medicare or desires a formal Medicare determination, the supplier must file a claim for that service to effectuate the beneficiary's right to a determination. Although, suppliers are not required to execute an Advance Beneficiary Notice of Noncoverage (ABN) since the item is considered noncovered, suppliers may execute an ABN as a voluntary notice to the beneficiary. For additional information on ABNs, please refer to chapter 10 of the Jurisdiction B Supplier Manual at: http://www.ngsmedicare.com/content.aspx?CatID=3&DOCID=235
For additional information on coding, please refer to Chapter 14 of the Jurisdiction B DME MAC Supplier manual at: http://www.ngsmedicare.com/content.aspx?CatID=3&DOCID=239
Registration and playback for the "On Demand" Medicare University 2009 Virtual Convention has been extended by popular demand to March 31, 2010.
National Government Services has extended the availability for registration and playback of the 2009 Medicare University Virtual Convention "On Demand" courses through March 31, 2010. For the low cost of $150, you have access to over 60 unique on-demand courses, not offered through Medicare University, at a time that is convenient for you. Plus, you can earn as many as 57 continuing education units!
Visit the Course page on the Medicare University 2009 Virtual Convention Web site to view a list of all the on-demand courses. After March 31, 2010 there is no turning back, so register today at www.NGSMEDICARECONVENTION.com
Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you!
National Government Services encourages all Web site users to provide feedback regarding ways to improve our Web site. The ForeSee Results (pop-up) survey is an easy mechanism for providers to use to let us know how we can best serve you. Your comments play a large role in the enhancements that are made to the National Government Services Web site.
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National Government Services has extended the availability for registration and playback of the 2009 Medicare University Virtual Convention "On Demand" courses through March 31, 2010. For the low cost of $150, you have access to over 60 unique on-demand courses, not offered through Medicare University, at a time that is convenient for you. Plus, you can earn as many as 57 continuing education units!
Visit the Course page on the Medicare University 2009 Virtual Convention Web site to view a list of all the on-demand courses. After March 31, 2010 there is no turning back, so register today at www.NGSMEDICARECONVENTION.com
Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you!
National Government Services encourages all Web site users to provide feedback regarding ways to improve our Web site. The ForeSee Results (pop-up) survey is an easy mechanism for providers to use to let us know how we can best serve you. Your comments play a large role in the enhancements that are made to the National Government Services Web site.
CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message.
To unsubscribe/change profile: click here.
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