SUPERSEDED LCD Reference Article Billing and Coding Article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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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Note History

Contractor Information

Article Information

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
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

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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

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

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Revenue Codes

Code Description
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CPT/HCPCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

99199 is the only code billable to this AB MAC

Group 1 Codes
Code Description
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
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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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.

Code Description
N/A

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.

Code Description
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 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
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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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.