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Durable Medical Equipment: Supply changes for electrical stimulation units

The Colorado Division of Workers’ Compensation (DOWC) set specific guidelines for billing electrical

January 23, 2018
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The Colorado Division of Workers’ Compensation (DOWC) set specific guidelines for billing electrical stimulation devices (durable medical equipment) and related supplies in 2018.

Beginning with dates of service in 2018, transcutaneous electrical nerve stimulation (TENS), all interferential machines and kits, and any other type of electrical stimulator combinations kits such as H-wave are to be billed with one of two codes:

  • E0720 — Device with two leads for localized stimulation
  • E0730 — Device with four or more leads for multiple nerve stimulation

Devices that cost $100 or less should be purchased according to the DOWC Rule 18.  Since the 2018 fee schedule reimbursement for both E0720 and E0730 is less than $100, these devices cannot be rented. They must be purchased in the first month.

Devices that cost more than $100 should be rented for the first month of use before a potential purchase. The provider should request prior authorization and document the effectiveness of the unit for the injured worker prior to purchasing devices priced over $100. The documentation of effectiveness should include the assessment of functional improvement and decreased pain.

Supplies used in conjunction with E0745 (NMES - Neuromuscular stimulator) and the devices, E0720 and E0370, should be billed with the following code:

  • A4595 — Electrical stimulator supplies, 2 lead, per month, (e.g., TENS, NMES)

This is the only code allowed for all monthly supplies used with a TENS, NMES, and all other electrical stim units. Code A4595 does not include the lead wires.

A4595 should be used for all supplies related to these devices.  Examples of what is included in A4595:

  • A4556 - Electrodes, per pair
  • A4558 - Conductive paste or gel used with electrical device (TENS, NMES), per ounce
  • A4630 - Replacement batteries, medically necessary, TENS, owned by patient
  • A4613 – Battery charger; replacement for patient owned ventilator
  • A5120 – Electrodes (e.g. apnea monitor), per pair

Supplies billed separately (unbundled) from A4595 will be denied.

Supplies are included in the initial setup and should not be billed separately in the first month.

After the first month, A4595 can be billed for replacement supplies:

  • For a two-lead device, the maximum reimbursement for supplies is one unit per month
  • For a device with four or more leads, the maximum reimbursement for supplies is two units per month

A4557 — Lead wires:

  • A4557 is not included in A4595.  A4557 can be billed separately and is only used for replacement wires.
  • A4557 should not be billed in the month the device is initially provided to the injured worker.
  • Pinnacol will only reimburse A4557 once per year for use with a TENS, NMES, or any other electrical stim unit.

Please note: per DOWC, Rule 18, auto shipping of monthly supplies is not allowed.  Supplies should only be sent if a request for additional supplies was completed by the injured worker or the payer.

Please note: per Rule 18, when the item is purchased, the rental fee will be deducted from the purchase price.

Reference:
https://www.colorado.gov/pacific/cdle/workers-compensation-rules-procedure (Rule 18-6, pages 46 – 48)

If you have any question or need additional information, please contact us at billingsuccess@pinnacol.com or 303.361.4940.

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