- Avoid Processing Delays by Following Proper Submission Guidelines
- Medicare Beneficiary Eligibility Checklist
- Acceptable Electronic Signatures Reminder
- Capable Recipients for the Advance Beneficiary Notice of Noncoverage
- Hospital-Issued Notices of Noncoverage
- Medicare Advance Written Notices of Noncoverage Booklet
- Primary Care Exception Guidelines
- Ordering DMEPOS Items
- Appropriate Use Criteria Program
- Assistant at Surgery Billing Documentation Reminder
- Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process
- Checking Eligibility and Knowing Your Point of Contact
- Cloned Documentation Could Result in Medicare Denials for Payment
- Documentation Reminder: Psychiatry and Psychology Services
- Documentation Required for Home Visits
- Electrical Stimulation Therapy: Important Coverage and Documentation Reminders
- Go Paperless Today - Protect Your Bottom Line
- Hospital Acquired Conditions and Present on Admission Resource for Physicians
- Inpatient Admission Prior to Medicare Entitlement Job Aid
- MDS Calendar
- Medicare Home Health Collaboration with Other Provider Types
- Part A Claims for High Cost Items and Certain Drugs Requiring Additional Information
- Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device
- Referring, Monitoring and Certifying Home Health Services
- Scribing Medical Record Documentation
- Skilled Nursing Facility Medicare Part A Benefit Quick Reference Fact Sheet
- Submit Medical Record Documentation Electronically
- Submitting Electronic Medical Records via CD or Thumb Drive
- Using the Medicare Part B PWK Fax-Mail-esMD Cover Sheet
Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device
VAD supplies and accessories are billed using HCPCS codes Q0507, Q0508 and Q0509 as applicable. When billing for VAD supplies, certain information is required with the claim submission.
Please provide the following information in the Remarks section of the claim to assist in pricing HCPCS code Q0508:
- Complete narrative description
- Brand name and model
- Current manufacturer catalog page and source (with price)
- Describe medical necessity
- Invoice price
- Name/title of professional performing service
- Indicate when original VAD surgery was performed and the payor
Proper use of HCPCS codes Q0507 through Q0509:
Claims for the replacement of supplies and accessories used with an external VAD that are furnished by hospitals and other providers should be billed to the Part A MAC using HCPCS code Q0507. Such claims are manually reviewed. Note that claims for the replacement of supplies and accessories used with an external VAD that are furnished by suppliers should be billed to the Part B MAC.
- Q0507 - Miscellaneous Supply Or Accessory For Use With An External Ventricular Assist Device
Claims for the replacement supplies and accessories used with implanted VADs that do not have specific HCPCS codes should be billed using HCPCS code Q0508, for which payment was made under Medicare Part A.
- Q0508 - Miscellaneous Supply or Accessory For Use With An Implanted Ventricular Assist Device
Claims for the replacement of accessories and supplies for VADs implanted in patients who were not eligible for coverage under Medicare Part A or had other insurance that paid for the device and hospital stay at the time the device was implanted, but are now eligible for coverage of the replacement supplies and accessories under Medicare Part B, should be submitted using HCPCS code Q0509. Such claims are manually reviewed.
- Q0509 - Miscellaneous Supply Or Accessory For Use With Any Implanted Ventricular Assist Device For Which Payment Was Not Made Under Medicare Part A
- Please provide (in remarks only) listed HCPCS codes and quantity of items billed for HCPCS code Q0509
Related Content:
- Change Request 12290, “National Coverage Determination (NCD) 20.9.1 Ventricular Assist Devices (VADs)”, effective 12/1/2020, includes:
- CMS Medlearn Matters article MM12290 “National Coverage Determination (NCD) 20.9.1 Ventricular Assist Devices (VADs)”
- Transmittal 10837 CMS Internet-Only Manual Publication 100-04, Medicare Claims Processing Manual
- Transmittal 10837 CMS IOM Publication 100-03, Medicare National Coverage Determinations
- NCD 20.9.1 Ventricular Assist Devices Coding Update ~ R10837CP1 (ZIP)
- Change Request 7888, “New Healthcare Common Procedure Coding System (HCPCS) Codes for Replacement Accessories and Supplies for External Ventricular Assist Devices or Any Ventricular Assist Device (VAD) for Which Payment Was Not Made Under Medicare Part A”, effective 4/1/2023
Posted 6/15/2023