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REIMBURSEMENT Q&A

Schaum, Kathleen D., MS

Section Editor(s): Hess, Cathy Thomas BSN, RN, CWOCN

Advances in Skin & Wound Care: May-June 2001 - Volume 14 - Issue 3 - p 114
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Kathleen D. Schaum, MS, is Director of Strategic Business Development, Wound Care Strategies, Inc, Harrisburg, PA.

Ms Schaum can be reached through her E-mail address: kdschaum@woundcarestrategies.com. Submit your payment issue questions in writing to Kathleen D. Schaum, MS, 6491 Rock Creek Drive, Lake Worth, FL, 33467; or by calling 561-964-2470.

Information on reimbursement is provided as a service to our readers, but does not constitute, guarantee, or warranty that payments will be provided. Providers are responsible for case-by-case management of qualification for reimbursement.

Reimbursement information for the products included in New Product News is suggested by the manufacturers and is meant as a guideline only. Practitioners should verify this information and its application to their individual circumstances before submitting claims for reimbursement.

Q: Most of the durable medical equipment (DME) suppliers in my area will not bill the DMERCs for collagen dressings. Many of them will sell collagen dressings only to patients who pay for them out-of-pocket. Do you have any suggestions for convincing the DME suppliers to stock collagen dressings and to bill Medicare Part B for them?

A: I personally prepared the application for new collagen HCPCS codes and for rates on the DMERC fee schedule. HCFA's positive response to this application should be great news to patients, professionals, and suppliers.

Effective January 1, 2001, the HCPCS code A6020, collagen based wound dressing, each dressing, was deleted. A 3-month grace period applies to the discontinued A6020 code for claims with dates of service January 1, 2001, through March 31, 2001. Claims received on or after April 1, 2001, must contain the new and correct collagen HCPCS codes.

Four new collagen HCPCS codes are effective with dates of service on or after January 1, 2001. These new codes are:

• A6021, collagen dressing, pad size 16 square inches or less, each

• A6022, collagen dressing, pad size more than 16 square inches, but less than or equal to 48 square inches, each

• A6023, collagen dressing, pad size more than 48 square inches, each

• A6024, collagen dressing, wound filler, per 6 inches.

HCFA's 2001 Medicare fee schedule for all states/DMERCs itemizes the fees assigned to these new codes. The ceiling and floor dollar amounts are the minimum and maximum Medicare allowable amounts for the corresponding HCPCS codes. Each state's specific Medicare allowable fees are itemized in Table 1. Because of these new collagen HCPCS codes, patients who qualify should have access to collagen dressings under Medicare Part B, and the DME suppliers should be willing to stock collagen dressings and to bill the DMERCs for them.

Table 1

Table 1

-Kathleen D. Schaum, MS

© 2001 Lippincott Williams & Wilkins, Inc.