Provider Alert: Durable Medical Equipment - Tape (Modifiers and NCCI Enforcement)
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This provider alert governs billing requirements for waterproof and non-waterproof medical tapes (DME supplies) for MedStar Family Choice District of Columbia members, including required modifiers and prospective pre-payment review edits; it affects providers submitting claims to MedStar Family Choice DC.
Prospective (pre-payment) reviews are being expanded to include additional edits based on CMS Coverage Policies and NCD guidance.
Waterproof and non-waterproof tapes must be billed with modifiers AU, AV, or AW depending on the type of supplies used; claims will be denied if the modifier is not included.
NCCI Manual policy and applicable modifiers that may bypass NCCI PTP edits are listed, emphasizing that codes billed the same day for the same member by the same provider may be denied as not separately reimbursable.
Billing and NCCI Enforcement for Tapes
Tape billing and NCCI enforcement
Billing and coding criteria for tapes and enforcement of NCCI correct coding edits.
ALL of the following
Modifiers that may be used to bypass NCCI PTP edits when clinically appropriate
- Anatomic modifiers: E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI
- Global surgery modifiers: 24, 25, 57, 58, 78, 79
- Other modifiers: 27, 59, 91, XE, XS, XP, XU
Required Modifiers, NCCI Bypass Modifiers, and Same-day Rules
| AU | Modifier for Urological supplies (example requirement for tape billing as applicable) |
| AV | Modifier for Ostomy supplies (example requirement for tape billing as applicable) |
| AW | Modifier for Tracheostomy/prosthetic/other supplies (example requirement for tape billing as applicable) |
| E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI | Anatomic modifiers that may be used to bypass NCCI PTP edits when clinically appropriate |
| 24, 25, 57, 58, 78, 79 | Global surgery modifiers that may be used to bypass NCCI PTP edits when clinically appropriate |
| 27, 59, 91, XE, XS, XP, XU | Other modifiers that may be used to bypass NCCI PTP edits when clinically appropriate |
What Providers Must Do
Attach AU/AV/AW modifiers; pre‑payment review will enforce
Include the supply-type modifier AU, AV, or AW on claims for waterproof and non-waterproof tapes as appropriate; claims submitted without the required modifier will be denied. Expect prospective (pre‑payment) reviews to enforce these modifier requirements as MedStar is expanding pre‑payment edits with its AMPS partner.
- Use AU, AV, or AW depending on the type of supplies (e.g., urological, ostomy, tracheostomy, prosthetic, orthotic, surgical dressings).
- Claims missing the AU/AV/AW modifier will be denied if the modifier is not included.
Key Terms and Modifiers
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