Superseded Local Coverage Article

Topical HBO and Physician Related Service Billing and Coding Guidelines

A56025

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Contractor Information

Article Information

General Information

Article ID
A56025
Article Title
Topical HBO and Physician Related Service Billing and Coding Guidelines
Article Type
Article
Original Effective Date
04/03/2017
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
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Article Guidance

Article Text

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

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 article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

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Revenue 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 article, 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 article should be assumed to apply equally to all Revenue Codes.

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CPT/HCPCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

99199 is the only code billable to the this AB MAC

Group 1 Codes
CodeDescription
99199 UNLISTED SPECIAL SERVICE, PROCEDURE OR REPORT
A4575 TOPICAL HYPERBARIC OXYGEN CHAMBER, DISPOSABLE
E0446 TOPICAL OXYGEN DELIVERY SYSTEM, NOT OTHERWISE SPECIFIED, INCLUDES ALL SUPPLIES AND ACCESSORIES

ICD-10-CM Codes that are Covered

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ICD-10-CM Codes that are Not Covered

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Revision History Information

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Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/16/2022 01/01/2023 - N/A Currently in Effect View
09/29/2020 04/03/2017 - 12/31/2022 Superseded View
06/13/2018 04/03/2017 - N/A Superseded You are here

Keywords

  • Topical oxygen,
  • Topical HBO,
  • treatment,
  • chronic wounds,
  • 99199,
  • A4575,
  • E0446