Effective for dates of service on or after November 1, 2021, HCPCS code A4459 (manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type) is added as a medical supply billing code, requiring a Treatment Authorization Request (TAR), on the List of Medical Supplies Billing Codes, Units and Quantity Limits.
In addition to TAR approval, claims submitted using HCPCS code A4459 require documentation of product cost (an invoice, manufacturer’s catalog page or price list) attached to the claim for reimbursement.
Effective for dates of service on or after January 1, 2022, claims with approved TARs using HCPCS code T5999 (supply, not otherwise classified) for reimbursement of a manual pump-operated enema system and its accessories will be denied.
Correction Made to Quantity Limits for Wound Care HCPCS Code A6245
The List of Medical Supplies Billing Codes, Units and Quantity Limits is updated with the correct quantity limits for wound care supply HCPCS code A6245, (hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing). The correct quantity limit without authorization for HCPCS code A6245 is 12 dressings per wound per 27-day period.