Brief: MAC clarifies CPAP policy

Sunday, September 26, 2010

WASHINGTON – National Government Services, the Jurisdiction B MAC, issued clarifying language in August on when a patient may switch from a CPAP (E0601) to a bi-level device (E0470). The treating physician must document that the beneficiary has been fitted with an appropriate interface and is using it without difficulty; and that the beneficiary cannot tolerate the current pressure setting of the E0601. Lower pressure settings must have been tried and failed. The change is effective for dates of service on or after Aug. 1, 2010.

Avoid disruptions for enteral patients, says association

WASHINGTON – The National Home Infusion Association (NHIA) has asked CMS to ensure that beneficiaries avoid disruptions in care under competitive bidding. In its comments on the 2011 physician fee schedule, the association asks CMS to extend grandfathering to all product categories. In the first round of the program in 2008, some beneficiaries had trouble finding enteral nutrition suppliers, while others encountered “winning” suppliers that had no experience in the category, according to the NHIA.

BOC offers model  for O&P legislation

OWINGS MILLS, M.D. – The Board of Certification/Accreditation, International (BOC) has developed a model state licensure act to give lawmakers a template for establishing practice standards, examinations, licensing, fees, education requirements, etc. Licensure for orthotists and prosthetists is already law in several states. The act is available in the advocacy section of BOC’s website at

Diabetic shoe

policy updated

WASHINGTON – National Government Services, the Jurisdiction B DME MAC, issued revisions to its therapeutic shoes local coverage determination in September. Orders for each item must be signed and dated by the prescribing physician, kept on file by the supplier and made available upon request. A new order is not required for the replacement of an insert or modification within one year, but the supplier’s records must document the reason for the replacement. Suppliers must get a signed statement from the treating physician certifying that the patient has diabetes, has one of six conditions listed in the related policy article, is being treated under a comprehensive plan of care and needs diabetic shoes.