Span Date Billing Guide

Certain DMEPOS items must be submitted with span dates according to the number of days the item or service is being rendered. When billing with span dates, the “From” date should reflect the date that the item was delivered or shipped, depending on the method of delivery (see Jurisdiction B DME MAC Supplier Manual, Chapter 8, Documentation, for date of service billing instructions). The “To” date should reflect the number of days that the quantity of dispensed supplies are expected to last. That number of days should be added to the “From” date. The “To” date will usually not be the end date of the time period that the item/service is intended to be used. For example, a 30-day quantity of supplies is delivered on June 25, 2009. They are expected to be used from July 1, 2009, until July 30, 2009. The span dates that should be billed are “From” June 25, 2009, “To” July 24, 2009. The July 24 date is 30 days after the delivery date. (Note: Different instructions apply to billing date spans for continuous passive motion devices.)

Claims with span dates of service may be submitted immediately after the “From” date and should not be held until after the “To” date. If additional supplies are needed before the end to the previous span date range, the claim can be submitted. In this situation, the “From” date of the new claim will be before the “To” date of the prior claim. When billing for refills, you are encouraged to review and follow the proof of delivery guidelines in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26.1, Proof of Delivery and Delivery Methods:

“For DMEPOS products that are supplied as refills to the original order, suppliers must contact the beneficiary prior to dispensing the refill. This shall be done to ensure that the refilled item is necessary and to confirm any changes/modifications to the order. Contact with the beneficiary or designee regarding refills should take place no sooner than approximately seven days prior to the delivery/shipping date. For subsequent deliveries of refills, the supplier should deliver the DMEPOS product no sooner than approximately five days prior to the end of usage for the current product. This is regardless of which delivery method is utilized. DME Medicare administrative contractors (MACs) shall allow for the processing of claims for refills delivered/shipped prior to the beneficiary exhausting his/her supply.”

You are reminded that claims for DMEPOS items other than those indicated in this article should not be billed with span dates. For the other DMEPOS items, the "From" date should be the date of delivery or the shipping date and the "To" date either should be left blank or should be the same as the “From” date. For rental items, the period of service is assumed to be one month.

The items listed below require span date billing. The next few paragraphs discuss and provide examples of how to bill for each using a span date.

Continuous passive motion device
Diabetic testing supplies
Parenteral and enteral nutrition

Note: This article should be used as a resource to help DMEPOS suppliers in span date billing and should not be used as a guide to determine if a DMEPOS item is covered by Medicare. DMEPOS suppliers are encouraged to review the local medical policies to ensure that their patient meets the Medicare coverage criteria and that all pertinent documentation requirements are met as indicated in each individual medical policy. Local medical policies can be accessed from the Medical Policy Center on our website.

Continuous Passive Motion Device

Continuous passive motion (CPM) devices are covered when the device is applied within two days following a total knee replacement. Coverage for this device is limited to the portion of the three-week period following surgery during which the device is used in the patient’s home. The span date instructions are different for CPM devices than they are for other items.

Key Things to Remember When Billing for a CPM Device

The “From” date should represent the date the beneficiary began to use the CPM device in their home.
The “To” date must represent the date the use of the CPM device ends.
The units of service billed should reflect the actual number of calendar days the CPM was used by the beneficiary in the home
Additional days billed beyond the three-week coverage period will be denied as not medically necessary with ANSI code CO-151.

In addition, suppliers must provide the following information in Item 19 of the CMS-1500 paper claim form or in Note (NTE) segment of the electronic version:

State the type of surgery performed (such as “total knee replacement”) or provide the CPT code for the surgical procedure (e.g., 27447, 27486, or 27487)
Date of the surgery
Date the device was initiated
Date of discharge from the hospital or nursing home (NH) (if the patient is discharged from the hospital to a SNF or rehabilitation center before going home, please use the discharge date when the patient went home)
Claims submitted without the required information will receive a CO-50 (These are noncovered services because this is not deemed a medical necessity by the payer) denial.

A suggested format for providing this information can be submitted as follows:

SURGERY DT 6/1/09 DT APPLIED 6/2/09 DT D/C HOME 6/5/09 CPT 27447

Example:

06/01/2009: Date of surgery
06/02/2009: Date that CPM device was applied
06/05/2009: Date of discharge from hospital/home use begins
06/22/2009: End of coverage
06/29/2009: Beneficiary use of device ends

Claim submission based upon above:

From date = 06/05/2009
To date = 06/29/2009
HCPCS/modifier = E0935RR
Units of service = 25 days (25 UOS)

Medicare will cover 18 days (June 5–22). The additional days will be denied CO-151 (Payment adjusted because the payer deemed the information submitted does not support this many/frequency of services) due to the excessive number of days beyond the three-week coverage period.

Diabetic Testing Supplies

Medicare will reimburse for blood glucose test strips (A4253) and lancets (A4259) when the patient has met the coverage criteria outlined in the local medical policy. The quantity of test strips and lancets allowed per month depends on whether or not the patient is treated with insulin injections. When billing for diabetic testing supplies, the claim must indicate whether or not the patient is insulin treated by appending the KX modifier (insulin treated) or the KS modifier (noninsulin treated) to the each claim line for the test strips and lancets. In addition to indicating whether or not the patient is insulin treated, the claim for the testing supplies must be spanned to reflect the number of days that the test strips that were dispensed are expected to last based on the frequency of testing ordered by the physician or performed by the beneficiary, whichever is less frequent.

Key Things to Remember When Billing for Diabetic Testing Supplies

The claim must indicate whether or not the patient is being treated by insulin (KX or KS modifiers)
A beneficiary or their caregiver must specifically request refills of glucose monitor supplies before they are dispensed. The supplier must not automatically dispense a quantity of supplies on a predetermined regular basis, even if the beneficiary has "authorized" this in advance. Contact with the beneficiary or designee regarding refills should take place no sooner than approximately seven days prior to the delivery/shipping date. For subsequent refill deliveries, the supplier should deliver the product no sooner than approximately five days prior to the end of usage for the current product.
The date of service for glucose test strips and lances must be spanned for complete claim adjudication. Failure to span the dates of service on a claim for glucose test strips and lancets will result in a CO-16 (Claim/service lacks information needed for adjudication) rejection.
The date span on the claim will generally not be the same as the actual dates of use by the beneficiary.
One unit of service for test strips (A4253) is equal to 50 strips.
One unit of service for lancets (A4259) is equal to 100 lancets.

Example:

Insulin treated beneficiary testing three times per day (KX modifier)
06/01/2009: 90-day supply—300 test strips (A4253) and 300 lancets (A4259)—is provided
08/29/2009: 90-day period after June 1 ends

Claim submission based upon the above information:

From date = 06/01/2009
To date = 08/29/2009
HCPCSmodifier = A4253KX
Units of service = 6
From date = 06/01/2009
To date = 08/29/2009
HCPCSmodifier = A4259KX
Units of service = 3

Parenteral/Enteral Nutrition

No more than one month's supply of PEN, equipment, or supplies may be dispensed at one time. Therefore, the maximum supply that can be billed at one time is a 31-day supply.

You must not automatically dispense a quantity of items on a predetermined regular basis, even if the beneficiary has "authorized" this in advance. It is your responsibility to assess how much nutrition and supplies the beneficiary is actually using by contacting the beneficiary or caregiver prior to dispensing the items. You must determine the quantities that remain from the previous delivery and modify the quantity delivered or the delivery date accordingly. If the beneficiary has not used all of their previously delivered nutrients/supplies, you should either delay delivery of the next shipment or should reduce the quantity delivered so that there is no more than one month’s supply on hand at any one time. This may occur in situations in which the beneficiary was admitted to the hospital or in which the beneficiary did not receive their usual nutrient intake because of an acute illness, etc.

Contact with the beneficiary or designee regarding refills should take place no sooner than approximately seven days prior to the delivery/shipping date. For subsequent refill deliveries, you should deliver the product no sooner than approximately five days prior to the end of usage for the current product. The Medicare system will allow up to a five-day overlap in dates of service for the processing of claims for refills delivered/shipped prior to the beneficiary exhausting his/her supply.

The supplier itself may deliver the PEN and supplies directly to the beneficiary or the supplier may use a shipping service to ship the items. If you deliver the items directly to the beneficiary, the “From” date of service on the claim will be the actual date the items were delivered. If you ship the items to the beneficiary using a shipping service, the “From” date of service will be the date the items were shipped. To determine the “To” date of service, the supplier counts the number of days the nutrients are expected to last (example: supplier ships a 28-day supply) and adds that number of days to the “From” date on the claim. Span dates on the claim will not usually match the dates of expected use of the nutrients.

Example: Supplier used a shipping service

Month 1

11/02/2009: 28-day supply shipped
11/04/2009: Beneficiary receives supply of nutrients
11/05/2009: Beneficiary starts using nutrients
12/02/2009: Beneficiary finishes supply of nutrients in this shipment
Dates of service on claim:
- From date = 11/02/2009 (date the nutrients were shipped)
- To date = 11/29/2009 (28 days after the from date since a 28-day supply was shipped)

Note that the span dates (“From” and “To” dates) are determined by the date the nutrients were shipped and the number of days for which the quantity shipped is expected to last. The span dates do not coincide with the dates the beneficiary actually used the nutrients.

Month 2

11/26/2009: Supplier calls beneficiary to determine beneficiary’s usage during the previous month and determines quantity of next shipment
11/30/2009: 28-day supply of nutrients shipped to beneficiary (expected dates of use 12/03/2009–12/30/2009)
12/02/2009: Beneficiary receives shipment
12/03/2009: Beneficiary begins using nutrients shipped
12/13/2009–12/17/2009: beneficiary admitted to inpatient hospital stay
01/04/2010: Beneficiary exhausts supply
Dates of service on claim:
- From date = 11/30/2009 (date the nutrients were shipped)
- To date = 12/27/2009 (28 days after the “From” date since a 28-day supply was shipped)

Shipping Supply Kits

Supply kits consist of multiple items which are sometimes shipped separately. As with nutrients, the span dates on the claim usually will not match the dates of expected use of the supplies.

Example: Supplier uses a shipping service

11/01/2009: 28-day supply of infusion pump bags and tubing shipped
11/08/2009: 28-day supply of irrigation syringes shipped
11/26/2009: 28-day supply of infusion pump bags and tubing shipped

Claim submission based upon above shipping example: