Negative Pressure Wound Therapy Using a Disposable Device

50.4.4 - Negative Pressure Wound Therapy Using a Disposable Device (Rev. 12382; Issued: 11-28-23; Effective: 01-01-24; Implementation:01-02-24) For services furnished on or after January 1, 2017 and before January 1, 2024, sections 1834 and 1861(m)(5) of the Act required a separate payment to an HHA for an applicable disposable device, to an individual who received home health services for which payment was made under the Medicare home health benefit. Section 1834 of the Act defines an applicable device as a disposable NPWT device that is an integrated system comprised of a non-manual vacuum pump, a receptacle for collecting exudate, and dressings for the purposes of wound therapy used in lieu of a conventional NPWT DME system. As required by §1834 of the Act, the separate payment amount for a disposable NPWT device was set equal to the amount of the payment that would be made under the Medicare Hospital Outpatient Prospective Payment System (OPPS) using the Level I HCPCS code, otherwise referred to as Current Procedural Terminology (CPT) codes, for which the description for a professional service includes the furnishing of such a device. Payment for HH visits related to wound care, but not requiring the furnishing of an entirely new disposable NPWT device, were covered by the HH PPS period payment and were billed using the HH claim. Where a home health visit was exclusively for the purpose of furnishing NPWT using a disposable device, the HHA submitted only a type of claim that was paid for separately outside the HH PPS (TOB 34x). Where, however, the home health visit included the provision of other home health services in addition to, and separate from, furnishing NPWT using a disposable device, the HHA submitted both a home health claim and a TOB 34x— the home health claim for other home health services and the TOB 34x for furnishing NPWT using a disposable device. EXAMPLE: A patient requires dNPWT for the treatment of a wound. On Monday, a nurse assesses a patient’s wound, applies a new disposable NPWT device, and provides wound care education to the patient and family. The nurse returns on Thursday for wound assessment and replaces the fluid management system (or dressing) for the existing disposable NPWT, but does not replace the entire device. The nurse returns the following Monday, assesses the patient’s condition and the wound, and replaces the device that had been applied on the previous Monday with a new disposable NPWT device. In this scenario, the billing procedures are as follows: For both Monday visits, all the services provided by the nurse were associated with furnishing NPWT using a disposable device. The nurse did not provide any services that were not associated with furnishing NPWT using a disposable device. Therefore, all the nursing services for both Monday visits should be reported on TOB 34x with CPT code 97607 or 97608. None of the services should be reported on the HH claim. For the Thursday visit, the nurse checked the wound, but did not apply a new disposable NPWT device, so even though the nurse provided care related to the wound, those services would not be considered furnishing NPWT using a disposable device. Therefore, the services should be reported on bill type 32x and no services should be reported on bill type 34x. For services furnished on or after January 1, 2024, Division FF, section 4136 of the Consolidated Appropriations Act of 2023 (CAA, 2023) (Pub. L.117-328) requires that beginning in CY 2024, there will be a separate payment amount for an applicable dNPWT device only and does not include payment for the nursing and therapy services. Payment for the device is equal to the supply price used to determine the relative value for the service under the Medicare Physician Fee Schedule (as of January 1, 2022) for the applicable disposable device and updated by the consumer price index for all urban consumers minus the productivity adjustment for each future year. Payment for nursing or therapy services, described in section 1861(m), to apply a disposable NPWT device would now be made under the prospective payment system established under section 1895, the HH PPS, and is no longer separately billable. Additionally, beginning in CY 2024 and each subsequent year, claims for the separate payment amount of an applicable dNPWT device would now be accepted and processed on claims submitted using the type of bill that is most commonly used by home health agencies to bill services under a home health plan of care (TOB 032x). That is, claims with a date of service on or after January 1, 2024 for an applicable dNPWT device will no longer be submitted on TOB 034x. EXAMPLE: A patient requires dNPWT for the treatment of a wound. On Monday, a nurse assesses a patient’s wound, applies a new disposable NPWT device, and provides wound care education to the patient and family. The nursing visit is reported on the home health claim as a home health visit using the appropriate G-code, revenue code and units of time on TOB 032x. Payment for these services are included in the overall HH PPS payment rate for the 30-day period of care if the LUPA threshold has been met for the period. The HHA would report the Healthcare Common Procedure Coding System (HCPCS) code A9272 (for the device only) on the home health type of bill TOB 032x. A separate payment is made for the device only. The nurse returns on Thursday for follow up teaching and assessment of the device. The nurse does not replace the dNPWT device at this visit. Only the nursing visit is reported on the home health claim using TOB 032x. No separate reporting for the device would be included on the claim since the device was not replaced during this visit. For instructions on billing for NPWT using a disposable device, see Pub. 100-04, Medicare Claims Processing Manual, chapter 10, Section 90.3 – Billing Instructions for Disposable Negative Pressure Wound Therapy Services.