INSURANCE CODES | HCPCS

Local Coverage Determinations (LCDs) provide guidance that assists providers in submitting correct claims for payment. LCDs also outline how the contractor will review claims to ensure that the services provided meet Medicare coverage requirements.

HCPCS Codes are numbers assigned to products and services provided to a Medicare patient. Developed by the American Medical Association, HCPCS Codes ensure uniformity in the billing process.

The following insurance codes apply to Cork Medical's current product line and are presented for reference purposes only.

Negative Pressure Wound Therapy

LCD L11489, Negative Pressure Wound Therapy Pumps

HCPCS Code E2402 describes a stationary or portable Negative Pressure Wound Therapy (NPWT) electrical pump which provides controlled sub-atmospheric pressure that is designed for use with NPWT dressings (A6550) and canisters (A7000) to promote wound healing. The NPWT pump must be capable of being selectively switched between continuous and intermittent modes of operation and is controllable to adjust the degree of sub-atmospheric pressure conveyed to the wound in a range of 40-80 mm Hg sub-atmospheric pressure. The system must contain sensors and alarms to monitor pressure variations and exudate volume in the collection canister.

HCPCS Code A6550 describes an allowance for a dressing set which is used in conjunction with a stationary or portable NPWT pump (E2402). A single code A6550 is used for each single, complete dressing change, and contains all necessary components, including but not limited to any separate, non-adherent porous dressing(s), drainage tubing, and an occlusive dressing(s) which creates a seal around the wound site for maintaining sub-atmospheric pressure at the wound.

HCPCS Code A7000 describes a canister set which is used in conjunction with a stationary or portable NPWT pump and contains all necessary components, including but not limited to a container, to collect wound exudate. Canisters may be various sizes to accommodate stationary or portable NPWT pumps.

 

Alternating Pressure | Group 2 Mattresses

LCD L11579, Pressure Reducing Support Surfaces - Group 2

Code E0277 describes a powered pressure reducing mattress (alternating pressure, low air loss, or powered flotation without low air loss) which is characterized by all of the following:

  • An air pump or blower which provides either sequential inflation and deflation of the air cells or a low interface pressure throughout the mattress, and

  • Inflated cell height of the air cells through which air is being circulated is 5 inches or greater, and

  • Height of the air chambers, proximity of the air chambers to one another, frequency of air cycling (for alternating pressure mattresses), and air pressure provide adequate beneficiary lift, reduce pressure and prevent bottoming out, and

  • A surface designed to reduce friction and shear, and

  • Can be placed directly on a hospital bed frame.

 

Non-Powered Group 2 Mattresses

LCD L27009, Nonpowered Pressure Mattresses - Group 2

Code E0373 describes an advanced nonpowered pressure reducing mattress which is characterized by ALL of the following:

  • Height and design of individual cells which provide significantly more pressure reduction than a Group 1 mattress and prevent bottoming out, and

  • Total height of 5 inches or greater, and

  • A surface designed to reduce friction and shear, and

  • Documented evidence to substantiate that the product is effective for the treatment of conditions described by the coverage criteria for Group 2 support surfaces, and

  • Can be placed directly on a hospital bed frame.

 

Gel Overlays | Group 1 Mattresses

LCD L11578, Pressure Reducing Support Surfaces - Group 1

Codes E0185 and E0197-E0199 termed "pressure pad for mattress" describe non-powered pressure reducing mattress overlays. These devices are designed to be placed on top of a standard hospital or home mattress.

A gel/gel-like mattress overlay (E0185) is characterized by a gel or gel-like layer with a height of 2 inches or greater.

An air mattress overlay (E0197) is characterized by interconnected air cells having a cell height of 3 inches or greater that are inflated with an air pump.

A water mattress overlay (E0198) is characterized by a filled height of 3 inches or greater.

A foam mattress overlay (E0199) is characterized by all of the following:

  • Base thickness of 2" or greater and peak height of 3" or greater if it is a convoluted overlay (e.g., eggcrate) or an overall height of at least 3 inches if it is a non-convoluted overlay, and

  • Foam with a density and other qualities that provide adequate pressure reduction, and

  • Durable, waterproof cover

 

Wheelchair Air Cushions

LCD L15670, Wheelchair Seating

Codes E2622, E2623 A skin protection seat cushion is covered for a patient who meets both of the following criteria:

  1. The patient has a manual wheelchair or a power wheelchair with a sling/solid seat/back and the patient meets Medicare coverage criteria for it; and

  2. The patient has either of the following:

    • Current pressure ulcer (ICD-9-CM codes 707.03, 707.04, 707.05) or past history of a pressure ulcer (707.03, 707.04, 707.05) on the area of contact with the seating surface; or

    • Absent or impaired sensation in the area of contact with the seating surface or inability to carry out a functional weight shift due to one of the following diagnoses: spinal cord injury resulting in quadriplegia or paraplegia (344.00-344.1), other spinal cord disease (336.0-336.3), multiple sclerosis (340), other demyelinating disease (341.0-341.9), cerebral palsy (343.0-343.9), anterior horn cell diseases including amyotrophic lateral sclerosis (335.0-335.21, 335.23-335.9), post polio paralysis (138), traumatic brain injury resulting in quadriplegia (344.09), spina bifida (741.00-741.93), childhood cerebral degeneration (330.0-330.9), Alzheimer's disease (331.0), Parkinson's disease (332.0),muscular dystrophy (359.0, 359.1), hemiplegia (342.00 – 342.92, 438.20-438.22), Huntington's chorea (333.4), idiopathic torsion dystonia (333.6), athetoid cerebral palsy (333.71).

 
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