Left Ventricular Assist Device (LVAD) Supplies
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Defines CareSource Georgia's reimbursement, coding, billing and prior authorization expectations for supplies, dressings, batteries, chargers, warranty and related billing for implanted and external LVADs; applies to providers submitting claims to CareSource (Marketplace: Georgia, Ohio, West Virginia).
Unlisted and miscellaneous codes were added to section F.
Background clarified that remote monitoring is not bundled and is separately reimbursable.
Prior authorization requirements and additions to documentation (V.B) were added.
Coverage Criteria for LVAD Supplies
Coverage criteria for LVAD supplies
CareSource considers LVAD supplies covered when ALL of the following criteria are met:
ALL of the following
ALL of the following
ALL of the following
- The initial dressings supplied under the bundled in‑patient benefit at the facility where the LVAD was implanted are expended.
The initial dressings supplied under the bundled in‑patient benefit at the facility where the LVAD was implanted must be used before outpatient dressing reimbursement is allowed.
- Dressings necessary for the effective use of a LVAD must be billed using the appropriate supply code.
- LVAD dressings are a disposable supply and must be billed as purchase‑only items.
- Supplies billed with miscellaneous code E1399 will be denied if a more appropriate code is available.
ALL of the following
- Batteries billed with miscellaneous code E1399 will be denied.
- A rechargeable battery may be approved with a spare to ensure uninterrupted use.
ALL of the following
- Battery chargers require periodic inspection and cleaning; hospital contact coordinates annual inspection and maintenance after discharge.
- Service and maintenance should only be performed by personnel trained by the manufacturer.
- Battery chargers that are repairable will not be replaced.
- CareSource may request warranty information for the DME item or supply; if items are covered by supplier's or manufacturer's warranty, CareSource will deny the claims.
ALL of the following
- Prior authorization submitted with unlisted or miscellaneous codes must include a complete item description (manufacturer, model/style, size), a list of all bundled components, and an itemization of charges.
- Current clinic notes listing the amount of dressing changes the member needs per week must be provided.
- Provide any other information requested by CareSource. Prior authorization is not a guarantee of payment.
ALL of the following
Any of the following are non‑covered
- Remote monitoring of LVADs using Q0508 or bundled codes is non‑covered.
- Multiple battery packs beyond the pair required for continuous use are non‑covered.
ALL of the following
- Claims must include an invoice.
- CareSource may verify use of any code through post‑payment audit and may request recoupment if a more appropriate code is discovered.
HCPCS and Miscellaneous Coding
| Q0503 | Battery for pneumatic ventricular assist device, replacement only, each |
| Q0506 | Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only |
| Q0507 | Miscellaneous supply or accessory for use with an external ventricular assist device |
| Q0508 | Miscellaneous supply or accessory for use with an implanted ventricular assist device |
| E1399 | Durable medical equipment, miscellaneous |
Prior Authorization, Documentation, and Claims Requirements
Prior authorization: unlisted/misc codes require detailed item-level documentation
Prior authorization for unlisted or miscellaneous codes (for example E1399, Q0507, Q0508) must include a complete description of the item (including, as applicable, manufacturer, model or style, and size), a list of all bundled components, and an itemization of all charges; current clinic notes documenting the amount/frequency of dressing changes per week; and any other information requested by CareSource. Prior authorization is not a guarantee of payment.
- Include manufacturer, model/style, and size for each unlisted/miscellaneous item
- List bundled components and provide an itemized charge breakdown
- Attach current clinic notes stating dressing-change frequency per week
- Provide any additional documentation requested by CareSource
Claims must include invoice; subject to post-payment audit and warranty denials
Claims for LVAD supplies must include an invoice; CareSource may perform post-payment audit and will deny or seek recoupment if a more appropriate code is identified or if items are covered by supplier/manufacturer warranty.
- Submit an invoice with every DME/supply claim
- Be prepared for post-payment audit and potential recoupment if billing errors or alternative codes are found
- Provide warranty information when requested — claims will be denied if supplier/manufacturer warranty covers the item
Definitions
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