SPECIAL BULLETIN COVID-19 #69: Clarification to Bulletin #15 Medicaid and NC Health Choice Temporary Flexibilities - 1135 Waiver Provisions and Replace Effective Dates Stated in Bulletins #2, #10 & #11

This Bulletin:

Clarifies which specific Prior Authorizations are being lifted on the March 1, 2020, effective date stated in SPECIAL BULLETIN COVID-19 #15: Medicaid and NC Health Choice Temporary Flexibilities - 1135 Waiver Provisions (posted March 24, 2020)
References all relevant Prior Authorization information included in other Bulletins
Replaces the effective dates originally stated in the following Bulletins:
- SPECIAL BULLETIN COVID-19 #2: General Guidance and Policy Modifications (posted Mar 13, 2020)
- SPECIAL BULLETIN COVID-19 #10: Durable Medical Equipment: Temporary Flexibilities Effective March 23, 2020 (posted Mar 24, 2020)
- SPECIAL BULLETIN COVID-19 #11: Outpatient Specialized Therapies Temporary Flexibilities (posted Mar 24, 2020)

The Centers for Medicare & Medicaid Services (CMS) has granted NC Medicaid the authority to temporarily modify Medicaid and NC Health Choice policies including reimbursement for Medically Necessary Services without Prior Authorizations. These temporary flexibilities will be effective through the end of the federal emergency declaration or when the flexibility is ended by NC Medicaid or CMS, whichever is first, unless otherwise indicated (such as PACE).

Reimbursement for Medically Necessary Services without Prior Authorization

Durable Medical Equipment (effective retroactive to March 1, 2020)
- PA suspended for oxygen equipment, ventilators, CPAPs, respiratory assist devices, nebulizers and related supplies (originally effective March 13, 2020)
- PA suspended to override quantity limits for sterile/non-sterile Gloves and incontinence supplies (originally effective March 13, 2020)
- PA suspended for six additional oxygen equipment and supply codes (originally effective March 23, 2020)
- PA suspended for non-preferred brand blood glucose testing supplies and for reauthorizations of continuous glucose monitors and supplies (originally effective March 23, 2020)
- PA suspended to override quantity limits on 41 respiratory equipment and supply codes (originally effective March 23, 2020)
- PA suspended to override quantity limits on nursing equipment and supplies including urinary catheters, ostomy supplies, gastrostomy and nasogastric tubes, enteral formula, and blood glucose testing supplies (originally effective March 23, 2020)
PA suspended for outpatient Respiratory Therapy provided through the Independent Practitioner Provider (IPP) program (effective retroactive to March 1, 2020; originally effective March 23, 2020)
Chest Computed Tomography (CT) Auto-Approval (effective March 24, 2020)
Pharmacy: Temporary Flexibilities (effective March 13, 2020)
Private Duty Nursing (PDN) (effective March 1, 2020)
- PA is temporarily lifted for additional PDN hours needed to cover unscheduled school closures for beneficiaries under age 21 with a current PA certification
- All beneficiaries: PA is temporarily lifted for short- term increase (STI) hours for any beneficiaries with a current PA certification
Home Health (effective March 1, 2020). PA is temporarily lifted for annual visit limits for home health aides and nursing
Program for All-Inclusive Care for the Elderly (PACE) (effective March 1-Dec. 31, 2020). Prior approval is temporarily lifted for PACE enrollment, including annual prior approvals. Prior approvals in place March 1 through Dec. 31, 2020, will remain in effect until the next scheduled due date in 2021. For example, an updated prior approval due March 2020 will be waived, and the next prior approval will be due March 2021

For the above categories, the effective dates are retroactive to the system changes made by the NC Medicaid. If a Provider submitted a claim for the above services after the effective date but received a denial, NC Medicaid encourages the provider to resubmit that claim.

Please see below for the details related to the categories above. These details have been covered by previous Bulletins released by NC Medicaid as noted.

Outpatient Specialized Therapies Temporary Flexibilities

This information is from SPECIAL BULLETIN COVID-19 #11: Outpatient Specialized Therapies Temporary Flexibilities (posted Mar 24, 2020). Update: The effective date originally listed in #11 is replaced by this bulletin.

Effective March 1, 2020, if medically necessary, outpatient Respiratory Therapy (RT) services provided through the Independent Practitioner Provider (IPP) program that typically require prior authorization (PA), may be provided to NC Medicaid and NC Health Choice beneficiaries without PA. All other aspects of Clinical Coverage Policy 10D, Respiratory Therapy Services by Independent Practitioner Provider will remain applicable.

Chest Computed Tomography (CT) Auto-Approval

This information is from SPECIAL BULLETIN COVID-19 #13: EviCore Chest Computed Tomography (CT) Auto-Approval (posted Mar 24).

Effective March 24, 2020, EviCore, NC Medicaid’s contracted vendor for imaging services, will auto-approve the following chest CT codes:

71250 – Computed tomography, thorax; without contrast material
71260 – Computed tomography, thorax; with contrast material(s)
71270 – Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections

A provider questionnaire will ask if the test is being requested due to COVID-19; if the answer is yes, the test will be automatically approved, regardless of diagnosis. If the answer is no, the request will process as usual.

As a reminder, if the CT is ordered by an urgent care facility or emergency department, the U2 modifier should be appended to the claim indicating that the test was performed emergently, and prior approval is not required.

Pharmacy: Temporary Flexibilities Effective March 13, 2020

This information is from SPECIAL BULLETIN COVID-19 #2: General Guidance and Policy Modifications (posted Mar 13, 2020).

Recommendations for social distancing in response to the COVID-19 present situations where Medicaid and Health Choice beneficiaries may benefit from an early refill or expanded quantity of their prescription medications.

Effective March 13, 2020 NC Medicaid enrolled pharmacy providers should resubmit these claims with “09” (Emergency Preparedness) in the PA Type Code field and a valid value for an E.R. override in the Reason for Service, Professional Service and Result of Service fields to override a denial for an early refill. Do not place any values in the Submission Clarification Code field.

This override code will allow for early refills and will also allow for coverage of up to a 90-day supply of the medication. Be aware that NC Medicaid policy allows a 90-day supply for brand and generics to be filled when the prescription is either written for a 90-day supply or has enough refills remaining to fill for up to 90 days.

Note that these edit changes do not apply to controlled substances. Additionally, providers are encouraged to follow all applicable state and federal laws and regulations for controlled substances.
If necessary, up to a 14-day emergency supply can be billed for any pharmacy claim requiring prior approval when no active prior approval is showing in NCTracks. The pharmacy provider should resubmit these claims with “09” (Emergency Preparedness) in the PA Type Code field and “03” in the Level of Service Field.
For beneficiaries in the Pharmacy Lock-in Program needing emergency supplies of Lock-In program-related medications, up to a 14-day emergency supply can be billed with “09” (Emergency Preparedness) in the PA Type Code field and “03” in the Level of Service Field. This override is only valid once per beneficiary per year. Beneficiaries and providers may also contact the NCTracks call center to change either the preferred Lock-In pharmacy or preferred Lock-In prescriber on an emergency basis.
Copay requirements are still applicable to these pharmacy claims.

Private Duty Nursing (PDN) – Beneficiaries Under 21 Years of Age

This information is from SPECIAL BULLETIN COVID-19 #5: Private Duty Nursing and Home Health Updates (posted Mar 19, 2020).

Clinical Coverage Policy 3G-2, Private Duty Nursing for Beneficiaries Under 21 Years of Age, allows for State Plan PDN services to be authorized whenever a beneficiary receiving nursing services through Local Education Agencies (LEAs) has an unscheduled school absence.

A parent or caregiver signed notification explaining any unscheduled school absences is required for PDN agency reimbursement of hours worked in the home.
Once required documentation has been received by NC Medicaid, the Prior Authorization (PA) for the affected time frame is adjusted to document the hours provided at the primary private residence.

Effective 3/1/2020, with the direction of Governor Cooper to close school systems state-wide due to COVID-19, NC Medicaid is temporarily lifting the requirement for PA to be obtained when additional PDN hours are needed to cover unscheduled school closures for beneficiaries that have a current PDN PA certification. Claims submitted may be subject to audit for each program.

Private Duty Nursing (PDN) – All Beneficiaries

Clinical Coverage Policy 3G-1, Private Duty Nursing for Beneficiaries Age 21 and Older, Section 3.4.1 and Clinical Coverage Policy 3G-2, Private Duty Nursing for Beneficiaries Under 21 Years of Age, Section 3.4.3, include coverage for a short- term increase (STI) in PDN services up to four (4) calendar weeks for a significant change in a beneficiary’s condition.

Refer to the policies addressed above for the qualifying conditions.
The amount and duration of the short-term increase is based on medical necessity and approved by NC Medicaid’s PDN Nurse Consultant.

Effective March 1, 2020, to avoid delays in beneficiaries receiving needed PDN STI services, NC Medicaid is temporarily lifting the requirement for PA to be obtained for STI hours for any PDN beneficiary that has a current PDN PA certification.

Home Health – All Beneficiaries

This information is from SPECIAL BULLETIN COVID-19 #5: Private Duty Nursing and Home Health Updates (posted Mar 19, 2020).

Clinical Coverage Policy 3A, Home Health Services, limits a beneficiary’s annual nursing visits to 75 per year and home health aide visits to 100 annually. Effective 3/1/2020, to support Home Health beneficiaries remaining in their residence and to lift the administrative burden for the providers during the COVID-19 outbreak, the visit limit is temporarily being lifted.

PACE Organizations

This information is from SPECIAL BULLETIN COVID-19 #27: Update for PACE Organizations (posted Mar 30, 2020).

PACE organizations should follow the guidance of the local, state and federal officials and thoroughly document reasoning for making decisions which may fall outside of the PACE program model. NC Medicaid will provide flexibilities in the following areas:

Enrollments – Effective April 1, 2020, PACE organizations have the option to temporarily suspend new enrollments. The PACE organization’s decision to temporarily suspend new enrollments should be communicated to NC Medicaid via memorandum. The communication should include the new enrollment suspension effective date as well as the timeframe for the suspension.
Initial Health and Safety Assessments – The Health and Safety assessment is conducted as a means of ensuring that the applicant’s health, safety or welfare will not be jeopardized by living in the community. The assessment requires an on-site evaluation. Due to COVID-19, effective March 1, 2020, the PACE organization has the option of delaying enrollment in the event the PACE organization cannot complete a Health and Safety assessment which considers all the following:
- An evaluation of the applicant’s residence either onsite or via remote technology;
- An evaluation of the applicant’s social support system, including the willingness and capabilities of all informal caregivers; and
- An evaluation of whether the applicant can be safely transported to the PACE Center.

The reason for the delay should be clearly documented and the local DSS notified about the delay by checking the revision box in section 2, page 2 of the 5106 form. The PACE organization should note the enrollment has been delayed and the proposed date of enrollment.

Annual Health and Safety Assessments – Effective March 1, 2020 – Dec. 31, 2020, annual Health and Safety assessments for currently enrolled participants may be completed either at the participant’s residence or via remote technology.
PACE Center Closures – PACE organizations have the option to close the Adult Day Health portion of its PACE Center to assist with promoting social distancing and preventing the spread of COVID-19 while maintaining the operation of the clinics and delivery of therapy services. The PACE organization should ensure the needs of participants normally addressed at the Adult Day Health portion of its PACE Center are able to be met in the participants’ homes.
PACE Center Attendance – As communicated by CMS, NC Medicaid supports limiting PACE participants from attending the PACE Center as a means of minimizing the potential for exposure to COVID-19. The attendance limit of a participant as a result of COVID-19 precautions will not be viewed by NC Medicaid as a service reduction and therefore will not be appealable by the participant. Participants should, however, be informed of their right to file a grievance. The PACE organization must discuss with and provide to the participant in writing the specific steps, including timeframes for response, that will be taken to resolve the participant’s grievance.
Annual FL2s – Clinical Policy 3B, Section 5.5.2 requires the PACE organization to submit an FL2 each calendar year to verify the enrollee continues to meet nursing facility level of care requirements. The submission of annual FL2s, for current participants will be waived beginning March 1, 2020 – Dec. 31, 2020. PACE participants will be deemed to meet nursing home level of care and deemed eligible for the PACE program until their next scheduled annual level of care review due in 2021 (e.g. if an annual FL2 is due in March 2020, the submission requirement of the March 2020 annual FL2 will be waived and the next annual FL2 will be due March 2021).
Prior Approvals – Clinical Policy 3B, Section 5.1 requires prior approval for PACE enrollment. The submission of annual prior approvals will be waived between March 1, 2020 – Dec. 31, 2020. Prior approvals in place during March 1, 2020 – Dec. 31, 2020, will remain in effect until the next scheduled due date in 2021 (e.g. if an updated prior approval is due March 2020, the submission requirement of the March 2020 prior approval will be waived and the next prior approval will be due March 2021).
Assessments/Reassessments – As communicated by CMS, NC Medicaid supports the use of remote technology as appropriate to complete scheduled and unscheduled participant assessments, care planning monitoring, communication and other related activities that would normally occur on an in-person basis. All assessment and reassessment timelines should be followed.

Durable Medical Equipment Temporary Flexibilities

The following information is from SPECIAL BULLETIN COVID-19 #10: Durable Medical Equipment: Temporary Flexibilities Effective March 23, 2020 (posted Mar 24, 2020) and SPECIAL BULLETIN COVID-19 #2: General Guidance and Policy Modifications (posted Mar 13, 2020). Update: The effective date originally listed in #2 and #10 is replaced by this bulletin.

Now Effective March 1, 2020, if medically necessary, the respiratory equipment and supplies listed below that typically require PA may be provided to beneficiaries with respiratory infections without first seeking PA.

HCPCS Code	Description
E0424	Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask and tubing.
E0431	Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask and tubing
E0433	Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge
E0434	Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing
E0439	Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask & tubing
E0445	Oximeter device for measuring blood oxygen levels non-invasively
E0465	Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)
E0466	Home ventilator, any type, used with noninvasive interface, (e.g., mask, chest shell)
E0470	Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device
E0471	Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
E0500	IPPB machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source
E0565	Compressor, air power source for equipment which is not self-contained, or cylinder driven
E0575	Nebulizer, ultrasonic, large volume
E0601	Continuous airway pressure (CPAP) device
E1356	Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each
E1357	Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each
E1358	Oxygen accessory, DC power adapter for portable concentrator, any type, replacement only, each
E1390	Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate
E1392	Portable oxygen concentrator, rental
K0738	Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing
W4001	CO2 saturation monitor with accessories, probes
W4670	Sterile saline, 3 cc vial, each
W4678	Replacement battery for portable suction pump

Effective March 1, 2020, if medically necessary, quantity limits on the following supplies may be exceeded when provided to beneficiaries with respiratory infections without first seeking PA:

HCPCS Code	Description
A4927	Gloves, non-sterile, per 100
A4930	Gloves, sterile, per pair
A4554	Disposable under pads, all sizes
T4521	Adult sized disposable incontinence product, brief/diaper, small, each
T4522	Adult sized disposable incontinence product, brief/diaper, medium, each
T4523	Adult sized disposable incontinence product, brief/diaper, large, each
T4524	Adult sized disposable incontinence product, brief/diaper, extra-large, each
T4525	Adult sized disposable incontinence product, protective underwear/pull on, small size, each
T4526	Adult sized disposable incontinence product, protective underwear/pull on, medium size, each
T4527	Adult sized disposable incontinence product, protective underwear/pull on, large size, each
T4528	Adult sized disposable incontinence product, protective underwear/pull on, extra-large size, each
T4529	Pediatric sized disposable incontinence product, brief/diaper, small/ medium size, each
T4530	Pediatric sized disposable incontinence product, brief/diaper, large size, each
T4531	Pediatric sized disposable incontinence product, protective underwear/pull on, small/medium size, each
T4532	Pediatric sized disposable incontinence product, protective underwear/pull on, large size, each
T4533	Youth sized disposable incontinence product, brief/diaper, each
T4534	Youth-sized disposable incontinence product, protective underwear/pull on, each
T4543	Disposable incontinence product, brief/diaper, bariatric, each
T4544	Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each

Effective March 1, 2020, if medically necessary, the following additional respiratory equipment and supplies that typically require PA may be provided to beneficiaries without first seeking PA:

HCPCS Code	Description
E0480	Percussor, electric or pneumatic, home model
E0482	Cough stimulating device, alternating positive and negative airway pressure
E0619	Apnea monitor, with recording feature
W4002	Manual ventilation bag (e.g., Ambu bag)
W4120	Disposable bags for Inspirease inhaler system, set of 3
W4153	Tracheostomy ties, twill

Now effective March 1, 2020, if medically necessary, the following nursing equipment and supplies that typically require PA may be provided to beneficiaries without first seeking PA:

HCPCS Code	Description
A4253	*Non-Preferred Brand: Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
A4256	*Non-Preferred Brand: Normal, low and high calibrator solution/chips
A4258	*Non-Preferred Brand: Spring-powered device for lancet, each
A4259	*Non-Preferred Brand: Lancets, per box of 100
A9276	**Sensor; invasive (e.g. subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1-day supply
A9277	**Transmitter; external, for use with interstitial continuous glucose monitoring system
A9278	**Receiver (monitor); external, for use with interstitial continuous glucose monitoring system
E2100	Blood glucose monitor with integrated voice synthesizer
K0739	Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes

*Preferred Roche brand blood glucose testing products do not require PA. See DME fee schedule for appropriate NDCs.
**Reauthorizations suspended for continuous glucose monitors and supplies. Initial PA still required.

Effective March 1, 2020, if medically necessary, quantity limits on the following respiratory equipment and supplies may be exceeded when provided to beneficiaries without first seeking PA:

HCPCS Code	Description
A4556	Electrodes (e.g., apnea monitor), per pair
A4557	Lead wires (e.g., apnea monitor), per pair
A4614	Peak expiratory flow rate meter, hand held
A4624	Tracheal suction catheter, any type, other than closed system, each
A4625	Tracheostomy care kit for new tracheostomy
A4627	Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler
A4628	Oropharyngeal suction catheter, each
A4629	Tracheostomy care kit for established tracheostomy
A7000	Canister, disposable, used with suction pump, each
A7001	Canister, non-disposable, used with suction pump, each
A7002	Tubing, used with suction pump, each
A7003	Administration set, with small volume nonfiltered pneumatic nebulizer, disposable
A7004	Small volume nonfiltered pneumatic nebulizer, disposable
A7005	Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable
A7006	Administration set, with small volume filtered pneumatic nebulizer
A7007	Large volume nebulizer, disposable, unfilled, used with aerosol compressor
A7010	Corrugated tubing, disposable, used with large volume nebulizer, 100 feet
A7012	Water collection device, used with large volume nebulizer
A7013	Filter, disposable, used with aerosol compressor or ultrasonic generator
A7015	Aerosol mask, used with DME nebulizer
A7020	Interface for cough stimulating device, includes all components, replacement only
A7027	Combination oral/nasal mask, used with continuous positive airway pressure device, each
A7028	Oral cushion for combination oral/nasal mask, replacement only, each
A7029	Nasal pillows for combination oral/nasal mask, replacement only, pair
A7030	Full face mask used with positive airway pressure device, each
A7031	Face mask interface, replacement for full face mask, each
A7032	Cushion for use on nasal mask interface, replacement only, each
A7033	Pillow for use on nasal cannula type interface, replacement only, pair
A7034	Nasal interface (mask or cannula type) used with positive airway pressure device with or without head strap
A7035	Headgear used with positive airway pressure device
A7036	Chinstrap used with positive airway pressure device
A7037	Tubing used with positive airway pressure device
A7038	Filter, disposable, used with positive airway pressure device
A7039	Filter, non-disposable, used with positive airway pressure device
A7526	Tracheostomy tube collar/holder, each
A9284	Spirometer, non-electronic, includes all accessories
E0484	Oscillatory positive expiratory pressure device, non-electric, any type, each
L8501	Tracheostomy speaking valve
S8185	Flutter device
W4120	Disposable bags for Inspirease inhaler system, set of 3
W4153	Tracheostomy ties, twill

Effective March 1, 2020, if medically necessary, quantity limits on the following nursing equipment and supplies may be exceeded when provided to beneficiaries without first seeking PA:

HCPCS Code	Description
A4213	Syringe, sterile, 20cc or greater, each
A4215	Needle, sterile, any size, each
A4230	Infusion set for external insulin pump, non-needle cannula type
A4231	Infusion set for external insulin pump, needle type
A4233	Replacement battery, alkaline (other than J cell), for use with medically necessary home blood glucose monitor owned by patient, each
A4234	Replacement battery, alkaline, J cell, for use with medically necessary home blood glucose monitor owned by patient, each
A4235	Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each
A4236	Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each
A4246	Betadine or pHisoHex solution, per pint
A4250	Urine test or reagent strips or tablets (100 tablets or strips)
A4252	Blood Ketone test or reagent strip, each
A4253	Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
A4256	Normal, low and high calibrator solution/chips
A4258	Spring-powered device for lancet, each
A4259	Lancets, per box of 100
A4310	Insertion tray without drainage bag and without catheter (accessories only)
A4311	Insertion tray without drainage bag with indwelling catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.)
A4313	Insertion tray without drainage bag with indwelling catheter, Foley type, three-way, for continuous irrigation
A4314	Insertion tray with drainage bag with indwelling catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.)
A4316	Insertion tray with drainage bag with indwelling catheter, Foley type, three-way, for continuous irrigation
A4320	Irrigation tray with bulb or piston syringe, any purpose
A4321	Therapeutic agent for urinary catheter irrigation
A4322	Irrigation syringe, bulb or piston, each
A4328	Female external urinary collection device; pouch, each
A4331	Extension drainage tubing, any type, any length, with connector/adapter, for use with urinary leg bag or urostomy pouch, each
A4334	Urinary catheter anchoring device, leg strap, each
A4335	Incontinence supply; miscellaneous
A4338	Indwelling catheter; Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.), each
A4340	Indwelling catheter; specialty type (e.g., coude, mushroom, wing, etc.), each
A4344	Indwelling catheter, Foley type, two-way, all silicone, each
A4349	Male external catheter, with or without adhesive, disposable, each
A4351	Intermittent urinary catheter; straight tip, with or without coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.), each
A4352	Intermittent urinary catheter; coude (curved) tip, with or without coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.), each
A4353	Intermittent urinary catheter, with insertion supplies
A4354	Insertion tray with drainage bag but without catheter
A4357	Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each
A4358	Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each
A4361	Ostomy faceplate, each
A4362	Skin barrier; solid, 4X4 or equivalent; each
A4364	Adhesive, liquid or equal, any type, per oz.
A4367	Ostomy belt, each
A4368	Ostomy filter, any type, each
A4369	Ostomy skin barrier, liquid (spray, brush, etc.), per oz.
A4371	Ostomy skin barrier, powder, per oz.
A4372	Ostomy skin barrier, solid 4X4 or equivalent, standard wear, with built-in convexity, each
A4373	Ostomy skin barrier, with flange (solid, flexible, or accordion), with built-in convexity, any size, each
A4375	Ostomy pouch, drainable, with faceplate attached, plastic, each
A4376	Ostomy pouch, drainable, with faceplate attached, rubber, each
A4377	Ostomy pouch, drainable, for use on faceplate, plastic each
A4378	Ostomy pouch, drainable, for use on faceplate, rubber, each
A4379	Ostomy pouch, urinary, with faceplate attached, plastic, each
A4380	Ostomy pouch, urinary, with faceplate attached, rubber, each
A4381	Ostomy pouch, urinary, for use on faceplate, plastic each
A4382	Ostomy pouch, urinary, for use on faceplate, heavy plastic, each
A4383	Ostomy pouch, urinary, for use on faceplate, rubber, each
A4384	Ostomy faceplate equivalent, silicone ring, each
A4385	Ostomy skin barrier, solid 4X4 or equivalent, extended wear, without built-in convexity, each
A4388	Ostomy pouch, drainable, with extended wear barrier attached (1 piece), each
A4389	Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each
A4390	Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each
A4391	Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each
A4392	Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each
A4393	Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each
A4394	Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce
A4395	Ostomy deodorant, for use in ostomy pouch, solid, per tablet
A4397	Irrigation supply; sleeve, each
A4398	Ostomy irrigation supply; bag, each
A4399	Ostomy irrigation supply; cone/catheter, with or without brush
A4400	Ostomy irrigation set
A4402	Lubricant, per ounce
A4404	Ostomy ring, each
A4405	Ostomy skin barrier, non-pectin based, paste, per ounce
A4406	Ostomy skin barrier, pectin-based, paste, per ounce
A4407	Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4X4 inches or smaller, each
A4408	Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, larger than 4X4 inches, each
A4409	Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, without built-in convexity, 4X4 inches or smaller, each
A4410	Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, without built-in convexity, larger than 4X4 inches, each
A4411	Ostomy skin barrier, solid 4X4 or equivalent, extended wear, with built-in convexity, each
A4414	Ostomy skin barrier, with flange (solid, flexible, or accordion), without built-in convexity, 4X4 inches or smaller, each
A4415	Ostomy skin barrier, with flange (solid, flexible, or accordion), without built-in convexity, larger than 4X4 inches, each
A4416	Ostomy pouch, closed, with barrier attached, with filter (1 piece), each
A4417	Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each
A4418	Ostomy pouch, closed, without barrier attached, with filter (1 piece), each
A4419	Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each
A4423	Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each
A4424	Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each
A4425	Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each
A4426	Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each
A4427	Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each
A4428	Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each
A4429	Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each
A4430	Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each
A4431	Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each
A4432	Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each
A4433	Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each
A4435	Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each
A4450	Tape, non-waterproof, per 18 square inches
A4452	Tape, waterproof, per 18 square inches
A4455	Adhesive remover or solvent (for tape, cement or other adhesive), per ounce
A4456	Adhesive remover, wipes, any type, each
A4554	Disposable underpads, all sizes
A5051	Ostomy pouch, closed; with barrier attached (1 piece), each
A5052	Ostomy pouch, closed; without barrier attached (1 piece), each
A5053	Ostomy pouch, closed; for use on faceplate, each
A5054	Ostomy pouch, closed; for use on barrier with flange (2 piece), each
A5055	Stoma cap
A5056	Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each
A5057	Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each
A5061	Ostomy pouch, drainable; with barrier attached, (1 piece), each
A5062	Ostomy pouch, drainable; without barrier attached (1 piece), each
A5063	Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each
A5071	Ostomy pouch, urinary; with barrier attached (1 piece), each
A5072	Ostomy pouch, urinary; without barrier attached (1 piece), each
A5073	Ostomy pouch, urinary; for use on barrier with flange (2 piece), each
A5093	Ostomy accessory; convex insert
A5102	Bedside drainage bottle with or without tubing, rigid or expandable, each
A5120	Skin barrier, wipes, or swabs, each
A5121	Skin barrier; solid, 6X6 or equivalent, each
A5122	Skin barrier; solid, 8X8 or equivalent, each
A5126	Adhesive or non-adhesive; disk or foam pad
A5131	Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
A6216	Gauze, non-impregnated, non-sterile, pad size 16 sq. in or less, without adhesive boarder, each dressing
A6257	Transparent film, sterile, 16 sq. in. or less, each dressing
A6258	Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
A7048	Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each
A9274	External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories
A9276	Sensor; invasive (e.g. subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1-day supply
A9999	Miscellaneous DME supply or accessory, not otherwise specified (For use with Farrell Valve only)
B4034	Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
B4036	Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
B4081	Nasogastric tubing with stylet
B4082	Nasogastric tubing without stylet
B4083	Stomach tube—Levine type
B4087	Gastrostomy/jejunostomy tube, standard, any material, any type, each
B4088	Gastrostomy/jejunostomy tube, low-profile, any material, any type, each
B4103	Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories=1 unit
B4150	Enteral formulae, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins, and minerals, may include fiber, administered through an enteral feeding tube, 100 calories= 1 unit
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories=1 unit
B4153	Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories=1 unit
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories=1 unit
B4155	Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g. glucose polymers), proteins/amino acids (e.g. glutamine, arginine), fat (e.g. medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories= 1unit
B4157	Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
B4158	Enteral formula, for pediatric nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 cal = 1 unit
B4159	Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 Cal = 1 unit
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 Cal = 1 unit
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 Cal = 1 unit
B4162	Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 Cal = 1 unit
K0552	Supplies for external drug infusion pump, syringe type cartridge, sterile, each
K0601	Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each
K0602	Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each
K0603	Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each
K0604	Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each
K0605	Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each
S8490	Insulin syringes (100 syringes, any size)

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