Medicare coverage for male vacuum erection kits ends July 1
The Centers for Medicare & Medicaid Services has clarified catheter collection guidelines in its most recent DMEPOS fee schedule announcement.
CMS said that HCPCS code A7048 describes supplies that include “the appropriately sized collection container, that are needed for a collection unit change when draining an implanted catheter. A7048 is used for each single, complete collection and represents a supply allowance rather than a specifically defined kit.”
Items included in this code are not limited to pre-packaged kits, CMS said. Supplies under A7048 include drainage tubing, gauze, dressings and collection units.
As part of the same guidance, Medicare will no longer reimburse for vacuum erection systems as of July 1. The Achieving A Better Life Experience Act of 2014 changed the Social Security Act to exclude these systems, CMS said. Effective July 1, contractors are told to deny claims with HCPCS codes L7900 and L7902.
The Office of the Inspector General recommended CMS “determine whether the payments for VES are grossly excessive and, if so, establish a special payment limit or seek legislative authority to include VES in the Competitive Bidding Program and then implement a National Mail-Order Competitive Bidding Program for VES” in a 2013 report. CMS concurred with both recommendations.
The guidance on DMEPOS is updated on a quarterly basis, when necessary, to implement fee schedule amounts for new codes and correct any fee schedule amounts for existing codes.