Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines

Effective April 3, 2017, the Centers for Medicare and Medicaid (CMS) decided that no National Coverage Determination (NCD) is appropriate at this time concerning the use of topical oxygen for the treatment of chronic wounds. As a result, CMS amended the NCD on Hyperbaric Oxygen Therapy (NCD 20.29) by removing Section C, Topical Application of Oxygen, and Medicare coverage of topical oxygen for the treatment of chronic wounds will be determined by the local Medicare Administrative Contractors (MACs). The CMS decision to remove the section on topical application of oxygen from the HBO NCD was because the topical application of oxygen does not meet the definition of hyperbaric oxygen therapy. (see CR 10220 issued 11/17/2017). In addition, CMS adds this note, “Though a MAC may decide to cover this procedure, there shall be no coverage for any separate or additional payment for any physician’s professional services related to this procedure.” Presently, the two HCPCS codes for topical oxygen therapy (E0446 and A4575) are designated as DME jurisdiction and since CMS has instructed the local MACs to not allow a physician service with topical oxygen, Noridian does not expect to see any claims for this service in either Part A or Part B. To bill for denial of related physician services enter 99199-related to Topical HBO in the comment/narrative field for the following Part B claim field/types: Loop 2400 or SV101-7 for the 5010A1 837P Item 19 for paper claims Sources CMS Change Request 10220; Transmittal 203 and Transmittal 3921 Internet Only Manual, Pub 100-04-Claims Processing Manual; Chapter 32, Section 30.2