A4479, Electronic transanal irrigation system, includes electronic pump, water reservoir, tubing, and accessories, without catheter, any type
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; for DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the signed SWO/WOPD must be received before delivery or the claim will be denied.
- For DMEPOS base items that require a WOPD, the WOPD must list the base item and may list separately billed associated options, accessories, and supplies; separately billed associated items without a completed signed WOPD of the base item will be denied.
- Claims must follow CMS HCPCS coding guidelines, LCDs, LCD-related Policy Articles, and DME MAC articles; claims not meeting coding guidelines shall be denied as not reasonable and necessary/incorrectly coded.
- Proof of delivery (POD) documentation is required to be maintained by the supplier and must be made available to the Medicare contractor upon request; services without appropriate POD shall be denied.
Key Coverage Criteria
- Bed pans (HCPCS E0275, E0276) are covered for beneficiaries who are bed-confined in accordance with NCD 280.1.
- Items must meet Medicare coverage rules: be within a defined Medicare benefit category, be reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meet all other Medicare statutory and regulatory requirements.
1 Active Policy
L36267, Bowel Management Devices
J19
Related Codes
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