Please note that this bulletin has been updated on April 26, 2022, to correct the effective date.
All temporary Durable Medical Equipment (DME) policy flexibilities outlined in COVID-19 Special Bulletins remain in effect as of this publication date. See COVID-19 Special Bulletins for details.
An amended version of Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies with an effective date of Feb. 1, 2022, was posted to the NC Medicaid Clinical Coverage Policy web page. Following is a summary of updates:
In Attachment A: Claims-Related Information, Section C: Procedure Code(s), the following updates were made:
- Quantity limits were updated from four per year to four per month for existing HCPCS codes A7520 (tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (PVC), silicone or equal, each), A7521 (tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (PVC) silicone or equal, each), and from one per month to four per month for A7525 (tracheostomy mask, each).
- Coverage and quantity limits were added for HCPCS codes A4604 (Tubing with integrated heating element for use with positive airway pressure device) and A7046 (Water chamber for humidifier, used with positive airway pressure device, replacement, each).
- As documented in the October 2009 NC Medicaid bulletin, eight asthma supply codes that can be issued and reimbursed for physicians, physician assistants, and nurse practitioners have been denoted with a plus (+) sign.
Additional Resources
The DME fee schedule and full text of Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies is available at NC Medicaid’s DME web page. All COVID-19 Special Bulletins are available here.