The new year brings several changes for DMEPOS providers from the Centers for Medicare & Medicaid Services (CMS). In addition, ACHC has revised one DMEPOS Accreditation Standard to align with CMS changes.

NEW BENEFIT CATEGORY

As of January 1, 2024, Medicare will now pay for lymphedema compression treatment items for Medicare Part B beneficiaries who have a prescription for the supplies.

CMS created a new Medicare DMEPOS benefit category — lymphedema compression treatment items — for standard and custom-fitted compression garments and other lymphedema compression treatment items, and added three new compression garment HCPCS codes, according to a recent MLN Matters article.

To accommodate the new benefit category, a new product code was created — S04 Lymphedema Compression Treatment Items.

ACHC Accreditation

The following ACHC Accreditation services cover provision of the new S04 product code:

• Home Medical Equipment (HME)
• Medical Supply Provider (MSP)
• Community Retail (CRTL) and Community Retail with Diabetic Shoes (CRDS)
• Fitter (FS)

If you are currently accredited for any of the above ACHC Accreditation services and would like to add S04 Lymphedema Compression Treatment Items as an accredited product code, contact your Account Advisor to start the process.

HME is the only accreditation service that also covers Pneumatic Compression Devices and/or Supplies (DM18). If you are entering the lymphedema market under a service other than HME but would also like to provide DM18 products, you should apply to include HME as a service addition. You can’t just add DM18 as an accredited product code.

PECOS: DMEPOS providers will not be able to add the new product code to their PECOS file until CMS updates its system. CMS said that it is working on getting this product code onto the 855S enrollment application so that suppliers can check it off if they will be furnishing it to beneficiaries. As that form is currently in clearance, CMS says it will likely not be approved and released to the public until about February.

Accrediting organizations, like ACHC, can start reporting the new product code to CMS beginning January 22, 2024. ACHC will not be able to report S04 as an accredited product until that date.

REFILL DOCUMENTATION UPDATES

New CMS requirements for documentation of DMEPOS refill requests also became effective January 1, 2024.

Refill Record Requirements

The refill record now must include:

• Beneficiary’s name or authorized representative, if different from the beneficiary.
• A description of each item that is being requested.
• Documentation of affirmative response indicating a need for refill.
• Date of refill request.

The quantity of an item on hand is no longer required to be documented nor is the condition/functionality of the item being replaced, such as a CPAP mask. In addition, suppliers may now contact the beneficiary regarding refills no sooner than 30 calendar days prior to the expected end of the current supply. This is a change from 14 days.

ACHC Updates Standard

To align with CMS documentation changes, ACHC has revised DMEPOS Standard DRX5-8A. Changes (shown below in blue) are effective January 1, 2024.

Standard DRX5-8A: The organization does not supply services or products that are not specifically requested by a client/patient or the physician*/practitioner that has responsibility for the client/patient care.

Client/patient records contain documentation that any product provided was ordered by the physician* and requested by the client/patient/caregiver. For refill orders, there is documentation in the client/patient record of the items needed for refill, confirmation of the need for the refill, quantity on hand, and who requested it.

*A physician or other licensed practitioner with prescribing authority.

Here for You

ACHC is your partner in accreditation. For more information, contact your Account Advisor, email [email protected], or call (855) 937-2242, ext. 458.