SUPERSEDED LCD Reference Article Billing and Coding Article

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

A56026

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General Information

Source Article ID
N/A
Article ID
A56026
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Topical HBO and Physician Related Service Billing and Coding Guidelines
Article Type
Billing and Coding
Original Effective Date
04/03/2017
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

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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

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ICD-10-CM Codes that Support Medical Necessity

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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Revenue Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2023 R2

Per 2023 CPT/HCPCS updates, either the long or short description of CPT code 99199 has been updated. 

04/03/2017 R1

Article converted to Billing and Coding, no other changes were made

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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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
11/08/2023 01/01/2023 - N/A Currently in Effect View
12/16/2022 01/01/2023 - N/A Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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