Updated Billing Guidelines for Disposable Negative Pressure Wound Therapy Devices in Home Health Care: Effective January 2024

As of January 1, 2024, Home Health Agencies (HHAs) are required to adhere to updated billing guidelines for disposable Negative Pressure Wound Therapy (NPWT) devices. These changes, significant for billing and payment processes within home health care, are designed to streamline claims and ensure accurate reimbursement.

Key Changes and Implementation

Under the new guidelines, disposable NPWT devices are to be billed and paid for separately on period of care claims using Type of Bill (TOB) 032x. This adjustment aims to improve the billing accuracy for disposable NPWT devices, ensuring that Medicare Administrative Contractors apply the appropriate deductibles and coinsurance amounts to these payments. It’s vital for HHAs’ billing staff to understand and implement these changes promptly.

Detailed Coding Instructions

HHAs must use the following coding details when submitting period of care claims for disposable NPWT devices:

  • Type of Bill (TOB): 032X. The 4th digit indicates the claim type, with “9” representing the final claim for an HH PPS period and “7” for the replacement of a prior claim.
  • Revenue Code: 027x (excluding 0274) for medical/surgical supplies.
  • HCPCS Code: A9272, covering wound suction disposable units, including dressing, all accessories, and components.
  • Service Date: Any date within the billing period that the device was applied. For multiple devices, the date of the first application.
  • Units: Indicate the number of devices provided during the billing period.
  • Charges: Must be reported according to the HHA’s policy for determining charges.

Exclusions and Previous Billing Practices

It’s important to note that the separate payment for applicable disposable NPWT devices provided on or after January 1, 2024, does not include payment for nursing or therapy services related to the application of the device. These services will now be covered under the Home Health Prospective Payment System (HH PPS) and are not separately billable.

Prior to CY 2024, Medicare made separate payments for NPWT using a disposable device under TOB 034x, which included both the device and related services. However, with the new guidelines, claims for disposable NPWT devices on TOB 034x for services on or after January 1, 2024, will be returned.

Resources for Further Information

These changes highlight the importance of staying informed on billing procedures to ensure compliance and secure appropriate reimbursement for services provided.