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Medical Supply Billing Codes Are Not Yet Updated to DME Supply Billing Codes

January 30, 2020

A previously published Medi-Cal Update article titled “Policy for Medical Supply Billing Codes Updated to DME Supply Billing Codes” notified providers that, effective for dates of service on or after February 1, 2020, certain medical supply billing codes are updated to Durable Medical Equipment (DME) supply billing codes, certain DME codes are added and certain medical supply codes policy is changed. The policy from that article will not be implemented at this time, including policy regarding benefit status and billing requirements. Until further notice, the following items continue to be reimbursable as medical supply codes and are not yet reimbursable as DME supply codes:

HCPCS Code Description
A4230 Infusion set for external insulin pump, non needle cannula type
A4231 Infusion set for external insulin pump, needle type
A4232 Syringe with needle for external insulin pump, sterile, 3 cc
A4483 Moisture exchanger, disposable, for use with invasive mechanical ventilation
A7002 Tubing, used with suction pump, each
A7003 Administration set, with small volume nonfiltered pneumatic nebulizer, disposable
A7004 Small volume nonfiltered pneumatic nebulizer, disposable
A7006 Administration set, with small volume filtered pneumatic nebulizer
A7007 Large volume nebulizer, disposable, unfilled, used with aerosol compressor
A7008 Large volume nebulizer, disposable, prefilled, used with aerosol compressor
A7010 Corrugated tubing, disposable, used with large volume nebulizer, 100 ft
A7012 Water collection device, used with large volume nebulizer
A7013 Filter, disposable, used with aerosol compressor or ultrasonic generator
A7016 Dome and mouthpiece, used with small volume ultrasonic nebulizer
B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
S8186 Swivel adaptor

Until further notice, medical supplies HCPCS code A4223 (infusion supplies not used with external infusion pump, per cassette or bag) continues to be reimbursable for infusion supplies with or without an infusion pump. HCPCS code A4222 (infusion supplies for external drug infusion pump, per cassette or bag) is not yet reimbursable as a DME supply.

Until further notice, the following HCPCS codes are not yet reimbursable:

HCPCS Code Description
A4224 Supplies for maintenance of insulin infusion catheter, per week
A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
E0574 Ultrasonic/electronic aerosol generator with small volume nebulizer

Until further notice, the following medical supplies codes are no longer end-dated and continue to be reimbursable:

HCPCS Code Description
B9998 Extension set for enteral feeding
B9999 Infusion supplies not otherwise classified
S1015 IV tubing extension set

Providers are encouraged to check the Medi-Cal website regularly for updates.

Updated manual pages and the updated Medical Supplies Billing Codes, Units and Quantity Limits spreadsheet reflecting this change will be released in a future Medi-Cal Update.