Hyperbaric Oxygen (HBO) Therapy
Contractor Information
|
Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 52280, 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - FI - MAC |
LCD Information
Document Information
DL31357 LCD Title Hyperbaric Oxygen (HBO) Therapy Contractor's Determination Number PHYS-056 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2010 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date Original Determination Ending Date Revision Effective Date For services performed on or after 02/21/2011 Revision Ending Date |
CMS National Coverage Policy
Pub. 100-3, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, §20.29, hyperbaric oxygen therapy.
42 CFR 410.32 defines direct physician supervision.
Federal Register, December 2, 1993 on page 63675
Title XVIII of the Social Security Act, section 1862(a)(7) excludes routine physical examinations.
Title XVIII of the Social Security Act, section 1862(a)(10) excludes coverage for cosmetic procedures.
Title XVIII of the Social Security Act, section 1862(a)(1)(A) only allows coverage and payment for those services that are considered to be medically reasonable and necessary.
42 CFR 410.32 defines direct physician supervision.
Federal Register, December 2, 1993 on page 63675
Title XVIII of the Social Security Act, section 1862(a)(7) excludes routine physical examinations.
Title XVIII of the Social Security Act, section 1862(a)(10) excludes coverage for cosmetic procedures.
Title XVIII of the Social Security Act, section 1862(a)(1)(A) only allows coverage and payment for those services that are considered to be medically reasonable and necessary.
Indications and Limitations of Coverage and/or Medical Necessity
For purposes of coverage under Medicare, hyperbaric oxygen (HBO) therapy is a modality in which the entire body is exposed to oxygen under increased atmospheric pressure. The patient is entirely enclosed in a pressure chamber breathing 100% oxygen (O 2) at greater than one atmosphere (atm) pressure. Either a monoplace chamber pressurized with pure O 2 or a larger multiplace chamber pressurized with compressed air where the patient receives pure O 2 by mask, head tent, or endotracheal tube may be used.)
Hyperbaric oxygen therapy serves four primary functions:
1. It increases the concentration of dissolved oxygen in the blood, which enhances perfusion;
2. It stimulates the formation of a collagen matrix so that new blood vessels may develop;
3. It replaces inert gas in the bloodstream with oxygen, which is then metabolized by the body; and
4. It works as a bactericide.
Developed as treatment for decompression illness, this modality is an established therapy for treating medical disorders such as carbon monoxide poisoning and gas gangrene. HBO is also considered acceptable in treating acute vascular compromise and as adjuvant therapy in the management of disorders that are refractory to standard medical and surgical care.
Covered Conditions Program reimbursement for HBO therapy will be limited to that which is administered in a chamber (including the one-man unit) and is limited to the following conditions. Portable chambers for smaller areas of the body are not covered.
1. Acute carbon monoxide intoxication
2. Decompression illness
3. Gas embolism,
4. Gas gangrene
5. Acute traumatic peripheral ischemia. HBO therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb, or life is threatened
6. Crush injuries and suturing of severed limbs. As in the previous conditions, HBO therapy would be an adjunctive treatment when loss of function, limb, or life is threatened
7. Progressive necrotizing infections (necrotizing fasciitis)
8. Acute peripheral arterial insufficiency
9. Preparation and preservation of compromised skin grafts (not for primary management of wounds)
10. Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management
11. Osteoradionecrosis as an adjunct to conventional treatment,
12. Soft tissue radionecrosis as an adjunct to conventional treatment
13. Cyanide poisoning
14. Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment
15. Effective April 1, 2003, a National Coverage Decision expanded the use of Hyperbaric Oxygen (HBO) therapy to include coverage for the treatment of diabetic wounds of the lower extremities in patients who meet the following criteria:
Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes
Patient has a wound classified as Wagner grade III or higher; and
Patient has failed an adequate course of standard wound therapy.
For the treatment of patients with diabetic wounds, the use of HBO therapy will be covered as adjunctive therapy only after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy and must be used in addition to standard wound care. Standard wound care in patients with diabetic wounds includes: assessment of a patient's vascular status and correction of any vascular problems in the affected limb if possible, optimization of nutritional status, optimization of glucose control, debridement by any means to remove devitalized tissue, maintenance of clean, moist bed of granulation tissue with appropriate moist dressings, appropriate off-loading, and necessary treatment to resolve any infection that might be present. Failure to respond to standard wound care occurs when there are no measurable signs of healing for at least 30 consecutive days. Wounds must be evaluated at least every 30 days during administration of HBO therapy. Continued treatment with HBO treatment is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment.
HBO should not be a replacement for other standard successful therapeutic measures. Depending on the response of the individual patient and the severity of the original problem, treatment may range from less than 1 week to several months duration, the average being 2 to 4 weeks.
While HBO can be a lifesaving or limb sparing procedure, there are a myriad of complications and precautions that are associated with HBO therapy. While most are not common, they are potentially severe and often life-threatening. While ruptured ear drums are the most likely, there are known problems concerning oxygen toxicity, chest pain, seizures, collapsed lungs, and anxiety. Thus, the physician supervising the treatment must evaluate the patient before the treatment begins, to insure that there is not an absolute, or even a relative contraindication for the HBO service. The evaluation must include, but is not limited to, neurological, pulmonary, and cardiac functions. More important, the physician supervising HBO should not only be cognizant of the potential problems of HBO therapy, he/she must be able to treat the complications. All treatment must be within the scope of practice of the supervising physician. The scope of practice of the supervising physician must include the ability to insert a chest tube and treat seizures. In addition, the physician's scope of practice must allow evaluation and treatment of sudden ear drum rupture and being able to distinguish between anxiety/claustrophobia, from true serious shortness of breath.
Physician Supervision
1. For professional services billed by a physician to Medicare B: Hyperbaric oxygen therapy services must be performed under the direct supervision of a physician. "Direct supervision" means the physician must be present in the facility and immediately available to furnish assistance and direction throughout the performance of the procedure. Physicians who perform HBO therapy are encouraged to obtain adequate training in the use of HBO therapy as well as both advanced cardiac life support (ACLS) and advanced trauma life support (ATLS) verification. The scope of practice of the supervising physician must include the ability to insert a chest tube and treat seizures. In addition, the physician's scope of practice must allow evaluation and treatment of sudden ear drum rupture and being able to distinguish between anxiety/claustrophobia, from true serious shortness of breath.
2. For technical services billed by a facility to Medicare A: HBO therapy rendered within a hospital outpatient department is considered "incident to" a physician's (MD/DO) services and requires physician supervision The physician supervision requirement is presumed to be met when services are performed on the hospital premises (i.e., certified as part of the hospital and part of the hospital campus.
Noncovered Conditions:
All other indications not specified under section 20.29 of the National Coverage Determinations Manual are not covered under the Medicare program. No program payment may be made for any conditions other than those listed in section 20.29 of the National Coverage Determinations Manual. (For an excerpt of the HBO NCD see the attached billing and coding guidelines for this LCD).
Hyperbaric oxygen therapy serves four primary functions:
1. It increases the concentration of dissolved oxygen in the blood, which enhances perfusion;
2. It stimulates the formation of a collagen matrix so that new blood vessels may develop;
3. It replaces inert gas in the bloodstream with oxygen, which is then metabolized by the body; and
4. It works as a bactericide.
Developed as treatment for decompression illness, this modality is an established therapy for treating medical disorders such as carbon monoxide poisoning and gas gangrene. HBO is also considered acceptable in treating acute vascular compromise and as adjuvant therapy in the management of disorders that are refractory to standard medical and surgical care.
Covered Conditions Program reimbursement for HBO therapy will be limited to that which is administered in a chamber (including the one-man unit) and is limited to the following conditions. Portable chambers for smaller areas of the body are not covered.
1. Acute carbon monoxide intoxication
2. Decompression illness
3. Gas embolism,
4. Gas gangrene
5. Acute traumatic peripheral ischemia. HBO therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb, or life is threatened
6. Crush injuries and suturing of severed limbs. As in the previous conditions, HBO therapy would be an adjunctive treatment when loss of function, limb, or life is threatened
7. Progressive necrotizing infections (necrotizing fasciitis)
8. Acute peripheral arterial insufficiency
9. Preparation and preservation of compromised skin grafts (not for primary management of wounds)
10. Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management
11. Osteoradionecrosis as an adjunct to conventional treatment,
12. Soft tissue radionecrosis as an adjunct to conventional treatment
13. Cyanide poisoning
14. Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment
15. Effective April 1, 2003, a National Coverage Decision expanded the use of Hyperbaric Oxygen (HBO) therapy to include coverage for the treatment of diabetic wounds of the lower extremities in patients who meet the following criteria:
Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes
Patient has a wound classified as Wagner grade III or higher; and
Patient has failed an adequate course of standard wound therapy.
For the treatment of patients with diabetic wounds, the use of HBO therapy will be covered as adjunctive therapy only after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy and must be used in addition to standard wound care. Standard wound care in patients with diabetic wounds includes: assessment of a patient's vascular status and correction of any vascular problems in the affected limb if possible, optimization of nutritional status, optimization of glucose control, debridement by any means to remove devitalized tissue, maintenance of clean, moist bed of granulation tissue with appropriate moist dressings, appropriate off-loading, and necessary treatment to resolve any infection that might be present. Failure to respond to standard wound care occurs when there are no measurable signs of healing for at least 30 consecutive days. Wounds must be evaluated at least every 30 days during administration of HBO therapy. Continued treatment with HBO treatment is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment.
HBO should not be a replacement for other standard successful therapeutic measures. Depending on the response of the individual patient and the severity of the original problem, treatment may range from less than 1 week to several months duration, the average being 2 to 4 weeks.
While HBO can be a lifesaving or limb sparing procedure, there are a myriad of complications and precautions that are associated with HBO therapy. While most are not common, they are potentially severe and often life-threatening. While ruptured ear drums are the most likely, there are known problems concerning oxygen toxicity, chest pain, seizures, collapsed lungs, and anxiety. Thus, the physician supervising the treatment must evaluate the patient before the treatment begins, to insure that there is not an absolute, or even a relative contraindication for the HBO service. The evaluation must include, but is not limited to, neurological, pulmonary, and cardiac functions. More important, the physician supervising HBO should not only be cognizant of the potential problems of HBO therapy, he/she must be able to treat the complications. All treatment must be within the scope of practice of the supervising physician. The scope of practice of the supervising physician must include the ability to insert a chest tube and treat seizures. In addition, the physician's scope of practice must allow evaluation and treatment of sudden ear drum rupture and being able to distinguish between anxiety/claustrophobia, from true serious shortness of breath.
Physician Supervision
1. For professional services billed by a physician to Medicare B: Hyperbaric oxygen therapy services must be performed under the direct supervision of a physician. "Direct supervision" means the physician must be present in the facility and immediately available to furnish assistance and direction throughout the performance of the procedure. Physicians who perform HBO therapy are encouraged to obtain adequate training in the use of HBO therapy as well as both advanced cardiac life support (ACLS) and advanced trauma life support (ATLS) verification. The scope of practice of the supervising physician must include the ability to insert a chest tube and treat seizures. In addition, the physician's scope of practice must allow evaluation and treatment of sudden ear drum rupture and being able to distinguish between anxiety/claustrophobia, from true serious shortness of breath.
2. For technical services billed by a facility to Medicare A: HBO therapy rendered within a hospital outpatient department is considered "incident to" a physician's (MD/DO) services and requires physician supervision The physician supervision requirement is presumed to be met when services are performed on the hospital premises (i.e., certified as part of the hospital and part of the hospital campus.
Noncovered Conditions:
All other indications not specified under section 20.29 of the National Coverage Determinations Manual are not covered under the Medicare program. No program payment may be made for any conditions other than those listed in section 20.29 of the National Coverage Determinations Manual. (For an excerpt of the HBO NCD see the attached billing and coding guidelines for this LCD).
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 013x | Hospital Outpatient |
| 085x | Critical Access Hospital |
Revenue Codes:
Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
CPT/HCPCS Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
| 0413 | Respiratory Services - Hyperbaric Oxygen Therapy |
| 0940 | Other Therapeutic Services - General Classification |
Note:
HCPCS code C1300 applies to Part A OPPS providers only.
CPT code 99183 applies to Non-Outpatient Prospective Payment System (Non-OPPS) providers only
HCPCS code C1300 applies to Part A OPPS providers only.
CPT code 99183 applies to Non-Outpatient Prospective Payment System (Non-OPPS) providers only
| 99183 | PHYSICIAN ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN THERAPY, PER SESSION |
| C1300 | HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL |
ICD-9 Codes that Support Medical Necessity
Claims for HBO for the treatment of diabetic wounds of the lower extremity require documentation of a dual diagnoses. Code first the associated underlying condition of diabetes mellitus (250.70-250.73 or 250.80-250.83), then the appropriate code to identify the manifestation of diabetic wounds of the lower extremities (ICD-9-CM codes 707.10, 707.11, 707.12, 707.13, 707.14, 707.15 or 707.19).
| 039.0 - 039.9 | CUTANEOUS ACTINOMYCOTIC INFECTION - ACTINOMYCOTIC INFECTION OF UNSPECIFIED SITE |
| 040.0 | GAS GANGRENE |
| 250.70 - 250.73 | DIABETES WITH PERIPHERAL CIRCULATORY DISORDERS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH PERIPHERAL CIRCULATORY DISORDERS, TYPE I [JUVENILE TYPE], UNCONTROLLED |
| 250.80 - 250.83 | DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED |
| 444.21 - 444.22 | ARTERIAL EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY - ARTERIAL EMBOLISM AND THROMBOSIS OF LOWER EXTREMITY |
| 444.81 | EMBOLISM AND THROMBOSIS OF ILIAC ARTERY |
| 526.89 | OTHER SPECIFIED DISEASES OF THE JAWS |
| 686.01 | PYODERMA GANGRENOSUM |
| 707.10 | UNSPECIFIED ULCER OF LOWER LIMB |
| 707.12 | ULCER OF CALF |
| 707.13 | ULCER OF ANKLE |
| 707.14 | ULCER OF HEEL AND MIDFOOT |
| 707.15 | ULCER OF OTHER PART OF FOOT |
| 707.19 | ULCER OF OTHER PART OF LOWER LIMB |
| 728.86 | NECROTIZING FASCIITIS |
| 730.10 | CHRONIC OSTEOMYELITIS SITE UNSPECIFIED |
| 730.11 - 730.19 | CHRONIC OSTEOMYELITIS INVOLVING SHOULDER REGION - CHRONIC OSTEOMYELITIS INVOLVING MULTIPLE SITES |
| 733.41 - 733.49 | ASEPTIC NECROSIS OF HEAD OF HUMERUS - ASEPTIC NECROSIS OF OTHER BONE SITES |
| 902.53 | INJURY TO ILIAC ARTERY |
| 903.01 | INJURY TO AXILLARY ARTERY |
| 903.1 | INJURY TO BRACHIAL BLOOD VESSELS |
| 903.2 | INJURY TO RADIAL BLOOD VESSELS |
| 903.3 | INJURY TO ULNAR BLOOD VESSELS |
| 904.0 | INJURY TO COMMON FEMORAL ARTERY |
| 904.1 | INJURY TO SUPERFICIAL FEMORAL ARTERY |
| 904.41 | INJURY TO POPLITEAL ARTERY |
| 904.51 | INJURY TO ANTERIOR TIBIAL ARTERY |
| 904.53 | INJURY TO POSTERIOR TIBIAL ARTERY |
| 909.2 | LATE EFFECT OF RADIATION |
| 925.1 - 929.9 | CRUSHING INJURY OF FACE AND SCALP - CRUSHING INJURY OF UNSPECIFIED SITE |
| 958.0 | AIR EMBOLISM AS AN EARLY COMPLICATION OF TRAUMA |
| 986 | TOXIC EFFECT OF CARBON MONOXIDE |
| 987.7 | TOXIC EFFECT OF HYDROCYANIC ACID GAS |
| 989.0 | TOXIC EFFECT OF HYDROCYANIC ACID AND CYANIDES |
| 990 | EFFECTS OF RADIATION UNSPECIFIED |
| 993.2 | OTHER AND UNSPECIFIED EFFECTS OF HIGH ALTITUDE |
| 993.3 | CAISSON DISEASE |
| 993.9 | UNSPECIFIED EFFECT OF AIR PRESSURE |
| 996.52 | MECHANICAL COMPLICATION OF PROSTHETIC GRAFT OF OTHER TISSUE NOT ELSEWHERE CLASSIFIED |
| 996.90 - 996.99 | COMPLICATIONS OF UNSPECIFIED REATTACHED EXTREMITY - COMPLICATION OF OTHER SPECIFIED REATTACHED BODY PART |
| 999.1 | AIR EMBOLISM AS A COMPLICATION OF MEDICAL CARE NOT ELSEWHERE CLASSIFIED |
Diagnoses that Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity
Any ICD-9-CM code not listed as covered in the "ICD-9 Codes that Support Medical Necessity" section of this policy.
| XX000 | Not Applicable |
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
General Information
Hospital/Outpatient records should clearly document the history and physical exam, a reason for the treatment, and a report of the treatment.
Medical documentation must include:
1. An initial assessment which will include a medical history detailing the condition requiring HBO. The medical history should list prior treatments and their results including antibiotic therapy and surgical interventions. This assessment should also contain information about adjunctive treatment currently being rendered;
2. Physician progress notes;
3. Any communication between physicians detailing past or future (proposed) treatments;
4. Positive gram-stain smear is required to support the diagnosis of gas gangrene;
5. Culture reports are required to confirm the diagnosis of Meleney's ulcer;
6. Definitive radiographic evidence OR bone culture with sensitivity studies are required to confirm the diagnosis of osteomyelitis;
7. In the treatment of diabetic wounds of the lower extremities, that the patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes; the patient has a wound classified as Wagner grade III or higher; and the patient has failed an adequate course of standard wound therapy.
8. HBO treatment records describing the physical findings, the treatment rendered and the effect of the treatment upon the established goals for therapy.
Effective January 1, 2005, the following may be included in calculating the total number of 30-minute intervals billable under C1300: (1) time spent by the patient under 100% oxygen; (2) descent; (3) airbreaks; and (4) ascent. This must be supported by the documentation.
NOTE: A physician order for a 90-minute HBO treatment typically means that the physician desires that the patient be placed under 100% oxygen for 90 minutes. In order to safely achieve 100% oxygen for 90 minutes, additional time may be needed to provide for the descent, airbreaks, and ascent. Therefore, the total number of billable 30-minute intervals would not be based solely on the amount of time noted on the physician order. In calculating how many 30-minute intervals to report, hospitals should take into consideration the time spent under pressure during descent, airbreaks, and ascent. Additional units may be billed for sessions requiring at least 16 minutes of the next 30-minute interval. For example, 2 units of HCPCS code C1300 should be billed for a session in duration of between 46 and 75 minutes, while 3 units should be billed for a session in duration of between 76 and 105 minutes. Furthermore, 4 units of HCPCS code C1300 should be billed for a session in duration of between 106 and 135 minutes. HBO is typically prescribed for an average of 90 minutes, which hospitals should report using appropriate units of HCPCS code C1300 in order to properly bill for full body HBO therapy. In general, we do not expect that a physician order for 90 minutes of HBO therapy would exceed 4 billed units of HCPCS code C1300.
Documentation for all services should be maintained on file to substantiate medical necessity for HBO treatment. Documentation must be submitted to Medicare upon request.
Appendices
Medical documentation must include:
1. An initial assessment which will include a medical history detailing the condition requiring HBO. The medical history should list prior treatments and their results including antibiotic therapy and surgical interventions. This assessment should also contain information about adjunctive treatment currently being rendered;
2. Physician progress notes;
3. Any communication between physicians detailing past or future (proposed) treatments;
4. Positive gram-stain smear is required to support the diagnosis of gas gangrene;
5. Culture reports are required to confirm the diagnosis of Meleney's ulcer;
6. Definitive radiographic evidence OR bone culture with sensitivity studies are required to confirm the diagnosis of osteomyelitis;
7. In the treatment of diabetic wounds of the lower extremities, that the patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes; the patient has a wound classified as Wagner grade III or higher; and the patient has failed an adequate course of standard wound therapy.
8. HBO treatment records describing the physical findings, the treatment rendered and the effect of the treatment upon the established goals for therapy.
Effective January 1, 2005, the following may be included in calculating the total number of 30-minute intervals billable under C1300: (1) time spent by the patient under 100% oxygen; (2) descent; (3) airbreaks; and (4) ascent. This must be supported by the documentation.
NOTE: A physician order for a 90-minute HBO treatment typically means that the physician desires that the patient be placed under 100% oxygen for 90 minutes. In order to safely achieve 100% oxygen for 90 minutes, additional time may be needed to provide for the descent, airbreaks, and ascent. Therefore, the total number of billable 30-minute intervals would not be based solely on the amount of time noted on the physician order. In calculating how many 30-minute intervals to report, hospitals should take into consideration the time spent under pressure during descent, airbreaks, and ascent. Additional units may be billed for sessions requiring at least 16 minutes of the next 30-minute interval. For example, 2 units of HCPCS code C1300 should be billed for a session in duration of between 46 and 75 minutes, while 3 units should be billed for a session in duration of between 76 and 105 minutes. Furthermore, 4 units of HCPCS code C1300 should be billed for a session in duration of between 106 and 135 minutes. HBO is typically prescribed for an average of 90 minutes, which hospitals should report using appropriate units of HCPCS code C1300 in order to properly bill for full body HBO therapy. In general, we do not expect that a physician order for 90 minutes of HBO therapy would exceed 4 billed units of HCPCS code C1300.
Documentation for all services should be maintained on file to substantiate medical necessity for HBO treatment. Documentation must be submitted to Medicare upon request.
1. Other Contractors' LCDs: Mississippi Carrier, Louisiana Part B, Missouri General American Life Insurance, Palmetto, Texas and Florida.
2. 2005 Health Care Common Procedure Coding System (HCPCS) National Level II Medicare Codes, Millennium Edition, Practice Management Information Corporation, 2004.
3. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), 6th Edition, Practice Management Information Corporation, 2004.
Italicized font €“ represents CMS national policy language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national policy language/wording. Providers, through their associations/societies, should contact CMS to request changes to national policy through the Medicare Coverage Policy Process at www.cms.gov/center/coverage.asp
An asterisk (*) indicates the most current revision.
NCDs are binding on all carriers, fiscal intermediaries, MAC Contractors, quality improvement organizations, health maintenance organizations, competitive medical plans, and health care prepayment plans. Under 42 CFR 422.256(b), an NCD that expands coverage is also binding on Medicare Advantage Organizations. In addition, an administrative law judge may not review an NCD. (See §1869(f)(1)(A)(i) of the Social Security Act.)
Advisory Committee Meeting Notes
2. 2005 Health Care Common Procedure Coding System (HCPCS) National Level II Medicare Codes, Millennium Edition, Practice Management Information Corporation, 2004.
3. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), 6th Edition, Practice Management Information Corporation, 2004.
Italicized font €“ represents CMS national policy language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national policy language/wording. Providers, through their associations/societies, should contact CMS to request changes to national policy through the Medicare Coverage Policy Process at www.cms.gov/center/coverage.asp
An asterisk (*) indicates the most current revision.
NCDs are binding on all carriers, fiscal intermediaries, MAC Contractors, quality improvement organizations, health maintenance organizations, competitive medical plans, and health care prepayment plans. Under 42 CFR 422.256(b), an NCD that expands coverage is also binding on Medicare Advantage Organizations. In addition, an administrative law judge may not review an NCD. (See §1869(f)(1)(A)(i) of the Social Security Act.)
Wisconsin 09/24/2010
Illinois 09/22/2010
Michigan 09/15/2010
Minnesota 09/16/2010
Iowa, Kansas, Missouri, Nebraska 10/07/2010
Open Meeting: 09/02/2010
Start Date of Comment Period
Illinois 09/22/2010
Michigan 09/15/2010
Minnesota 09/16/2010
Iowa, Kansas, Missouri, Nebraska 10/07/2010
Open Meeting: 09/02/2010
10/07/2010
End Date of Comment Period
11/21/2010
Start Date of Notice Period
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
02/21/2011 In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
Reason for Change
02/21/2011 In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
03/01/2011
Related Documents
This LCD has no Related Documents.
LCD Attachments
Coding and Billing Guidelines for DRAFT (PDF - 32,587 bytes )
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