Program Memorandum

Department of Health and Human Services (DHHS)



Transmittal AB-01-65

Date: APRIL 26, 2001


Change Request 1622

SUBJECT: Procedures Subject to Home Health Consolidated Billing

HCFA previously released a listing of procedures that were subject to home health consolidated billing effective October 1, 2000. Based upon revisions to the procedure codes, we are issuing a new list of procedures (Attachments A and B) that, when billed by various types of providers submitting claims to either Medicare intermediaries or carriers at the same time as a home health episode are subject to denial because payment is provided to the home health agency creating the episode.

Attachment A is a list of 194 non-routine supply codes that replaces the previous list of 178.

Attachment B is a list of 69 therapy codes that replaces the previous list of 54.

The previous lists were published in Program Memorandum (PM) B-00-50, October 12, 2000. The new lists of procedures are effective for claims with dates of service January 1, 2001 through December 31, 2001 that are submitted to the carrier or intermediary July 1, 2001 and later.

Yearly updates to this list of procedures will be issued in conjunction with the release of the yearly HCPCS update.

Educate providers that these procedure codes, when billed during a home health episode, are subject to home health consolidated billing.


The effective date of this PM is July 1, 2001.

The implementation date of this PM is July 1, 2001.

These instructions should be implemented within your current operating budget.

This PM may be discarded after July 1, 2002.

Contractors should contact the appropriate regional office.

HCFA Pub. 60A/B

194 Non-Routine Supply Codes

A4212 Non coring needle or stylet
A4310 Insert tray w/o bag/cath
A4311 Catheter w/o bag 2-way latex
A4312 Cath w/o bag 2-way silicone
A4313 Catheter w/bag 3-way
A4314 Cath w/drainage 2-way latex
A4315 Cath w/drainage 2-way silcne
A4316 Cath w/drainage 3-way
A4319 Sterile H2O irrigation solut
A4320 Irrigation tray
A4321 Cath therapeutic irrig agent
A4322 Irrigation syringe
A4323 Saline irrigation solution
A4324 Male ext cath w/adh coating
A4325 Male ext cath w/adh strip
A4326 Male external catheter
A4327 Fem urinary collect dev cup
A4328 Fem urinary collect pouch
A4329 External catheter start set
A4330 Stool collection pouch
A4331 Extension drainage tubing
A4332 Lubricant for cath insertion
A4333 Urinary cath anchor device
A4334 Urinary cath leg strap
A4335 Incontinence supply
A4338 Indwelling catheter latex
A4340 Indwelling catheter special
A4344 Cath indw foley 2 way silicn
A4346 Cath indw foley 3 way
A4347 Male external catheter
A4348 Male ext cath extended wear
A4351 Straight tip urine catheter
A4352 Coude tip urinary catheter
A4353 Intermittent urinary cath
A4354 Cath insertion tray w/bag
A4355 Bladder irrigation tubing
A4356 Ext ureth clmp or compr dvc
A4357 Bedside drainage bag
A4358 Urinary leg bag
A4359 Urinary suspensory w/o leg b
A4361 Ostomy face plate
A4362 Solid skin barrier
A4364 Liq adhes for facial prosth
A4365 Adhesive remover wipes
A4367 Ostomy belt
A4368 Ostomy filter
A4369 Skin barrier liquid per oz
A4370 Skin barrier paste per oz
A4371 Skin barrier powder per oz
A4372 Skin barrier solid 4x4 equiv
A4373 Skin barrier with flange
A4374 Skin barrier extended wear
A4375 Drainable plastic pch w fcpl
A4376 Drainable rubber pch w fcplt
A4377 Drainable plstic pch w/o fp
A4378 Drainable rubber pch w/o fp
A4379 Urinary plastic pouch w fcpl
A4380 Urinary rubber pouch w fcplt
A4381 Urinary plastic pouch w/o fp
A4382 Urinary hvy plstc pch w/o fp
A4383 Urinary rubber pouch w/o fp
A4384 Ostomy faceplt/silicone ring
A4385 Ost skn barrier sld ext wear
A4386 Ost skn barrier w flng ex wr
A4387 Ost clsd pouch w att st barr
A4388 Drainable pch w ex wear barr
A4389 Drainable pch w st wear barr
A4390 Drainable pch ex wear convex
A4391 Urinary pouch w ex wear barr
A4392 Urinary pouch w st wear barr
A4393 Urine pch w ex wear bar conv
A4394 Ostomy pouch liq deodorant
A4395 Ostomy pouch solid deodorant
A4396 Peristomal hernia supprt blt
A4397 Irrigation supply sleeve
A4398 Ostomy irrigation bag
A4399 Ostomy irrig cone/cath w brs
A4400 Ostomy irrigation set
A4402 Lubricant per ounce
A4404 Ostomy ring each
A4421 Ostomy supply misc
A4455 Adhesive remover per ounce
A4460 Elastic compression bandage
A4462 Abdmnl drssng holder/binder
A4481 Tracheostoma filter
A4622 Tracheostomy or larngectomy
A4623 Tracheostomy inner cannula
A4625 Trach care kit for new trach
A4626 Tracheostomy cleaning brush
A4649 Surgical supplies
A5051 Pouch clsd w barr attached
A5052 Clsd ostomy pouch w/o barr
A5053 Clsd ostomy pouch faceplate
A5054 Clsd ostomy pouch w/flange
A5055 Stoma cap
A5061 Pouch drainable w barrier at
A5062 Drnble ostomy pouch w/o barr
A5063 Drain ostomy pouch w/flange
A5071 Urinary pouch w/barrier
A5072 Urinary pouch w/o barrier
A5073 Urinary pouch on barr w/flng
A5081 Continent stoma plug
A5082 Continent stoma catheter
A5093 Ostomy accessory convex inse
A5102 Bedside drain btl w/wo tube
A5105 Urinary suspensory
A5112 Urinary leg bag
A5113 Latex leg strap
A5114 Foam/fabric leg strap
A5119 Skin barrier wipes box pr 50
A5121 Solid skin barrier 6x6
A5122 Solid skin barrier 8x8
A5123 Skin barrier with flange
A5126 Disk/foam pad +or- adhesive
A5131 Appliance cleaner
A6020 Collage wound dressing
A6021 Collagen dressing <=16 sq in
A6022 Collagen drsg>6<=48 sq in
A6023 Collagen dressing >48 sq in
A6024 Collagen dsg wound filler
A6154 Wound pouch each
A6196 Alginate dressing <=16 sq in
A6197 Alginate drsg >16 <=48 sq in
A6198 alginate dressing > 48 sq in
A6199 Alginate drsg wound filler
A6200 Compos drsg <=16 no border
A6201 Compos drsg >16<=48 no bdr
A6202 Compos drsg >48 no border
A6203 Composite drsg <= 16 sq in
A6204 Composite drsg >16<=48 sq in
A6205 Composite drsg > 48 sq in
A6206 Contact layer <= 16 sq in
A6207 Contact layer >16<= 48 sq in
A6208 Contact layer > 48 sq in
A6209 Foam drsg <=16 sq in w/o bdr
A6210 Foam drg >16<=48 sq in w/o b
A6211 Foam drg > 48 sq in w/o brdr
A6212 Foam drg <=16 sq in w/border
A6213 Foam drg >16<=48 sq in w/bdr
A6214 Foam drg > 48 sq in w/border
A6215 Foam dressing wound filler
A6219 Gauze <= 16 sq in w/border
A6220 Gauze >16 <=48 sq in w/bordr
A6221 Gauze > 48 sq in w/border
A6222 Gauze <=16 in no w/sal w/o b
A6223 Gauze >16<=48 no w/sal w/o b
A6224 Gauze > 48 in no w/sal w/o b
A6228 Gauze <= 16 sq in water/sal
A6229 Gauze >16<=48 sq in watr/sal
A6230 Gauze > 48 sq in water/salne
A6231 Hydrogel dsg<=16 sq in
A6232 Hydrogel dsg>16<=48 sq in
A6233 Hydrogel dressing >48 sq in
A6234 Hydrocolld drg <=16 w/o bdr
A6235 Hydrocolld drg >16<=48 w/o b
A6236 Hydrocolld drg > 48 in w/o b
A6237 Hydrocolld drg <=16 in w/bdr
A6238 Hydrocolld drg >16<=48 w/bdr
A6239 Hydrocolld drg > 48 in w/bdr
A6240 Hydrocolld drg filler paste
A6241 Hydrocolloid drg filler dry
A6242 Hydrogel drg <=16 in w/o bdr
A6243 Hydrogel drg >16<=48 w/o bdr
A6244 Hydrogel drg >48 in w/o bdr
A6245 Hydrogel drg <= 16 in w/bdr
A6246 Hydrogel drg >16<=48 in w/b
A6247 Hydrogel drg > 48 sq in w/b
A6248 Hydrogel drsg gel filler
A6251 Absorpt drg <=16 sq in w/o b
A6252 Absorpt drg >16 <=48 w/o bdr
A6253 Absorpt drg > 48 sq in w/o b
A6254 Absorpt drg <=16 sq in w/bdr
A6255 Absorpt drg >16<=48 in w/bdr
A6256 Absorpt drg > 48 sq in w/bdr
A6257 Transparent film <= 16 sq in
A6258 Transparent film >16<=48 in
A6259 Transparent film > 48 sq in
A6261 Wound filler gel/paste /oz
A6262 Wound filler dry form / gram
A6266 Impreg gauze no h20/sal/yard
A6402 Sterile gauze <= 16 sq in
A6403 Sterile gauze>16 <= 48 sq in
A6404 Sterile gauze > 48 sq in
A6405 Sterile elastic gauze /yd
A6406 Sterile non-elastic gauze/yd
A7501 Tracheostoma valve w diaphra
A7502 Replacement diaphragm/fplate
A7503 HMES filter holder or cap
A7504 Tracheostoma HMES filter
A7505 HMES or trach valve housing
A7506 HMES/trachvalve adhesivedisk
A7507 Integrated filter & holder
A7508 Housing & Integrated Adhesiv
A7509 Heat & moisture exchange sys

69 Therapy Codes

G0193 Endoscopicstudyswallowfunctn
G0194 Sensorytestingendoscopicstud
G0195 Clinicalevalswallowingfunct
G0196 Evalofswallowingwithradioopa
G0197 Evalofptforprescipspeechdevi
G0198 Patientadapation&trainforspe
G0199 Reevaluationofpatientusespec
G0200 Evalofpatientprescipofvoicep
G0201 Modifortraininginusevoicepro
64550 Apply neurostimulator
90901 Biofeedback train, any meth
90911 Biofeedback peri/uro/rectal
92506 Speech/hearing evaluation
92507 Speech/hearing therapy
92508 Speech/hearing therapy
92510 Rehab for ear implant
92525 Oral function evaluation
92526 Oral function therapy
92597 Oral speech device eval
92598 Modify oral speech device
95831 Limb muscle testing, manual
95832 Hand muscle testing, manual
95833 Body muscle testing, manual
95834 Body muscle testing, manual
95851 Range of motion measurements
95852 Range of motion measurements
96105 Assessment of aphasia
97001 Pt evaluation
97002 Pt re-evaluation
97003 Ot evaluation
97004 Ot re-evaluation
97012 Mechanical traction therapy
97014 Electric stimulation therapy
97016 Vasopneumatic device therapy
97018 Paraffin bath therapy
97020 Microwave therapy
97022 Whirlpool therapy
97024 Diathermy treatment
97026 Infrared therapy
97028 Ultraviolet therapy
97032 Electrical stimulation
97033 Electric current therapy
97034 Contrast bath therapy
97035 Ultrasound therapy
97036 Hydrotherapy
97039 Physical therapy treatment
97110 Therapeutic exercises
97112 Neuromuscular reeducation
97113 Aquatic therapy/exercises
97116 Gait training therapy
97124 Massage therapy
97139 Physical medicine procedure
97140 Manual therapy
97150 Group therapeutic procedures
97504 Orthotic training
97520 Prosthetic training
97530 Therapeutic activities
97532 Cognitive skills development
97533 Sensory integration
97535 Self care mngment training
97537 Community/work reintegration
97542 Wheelchair mngment training
97545 Work hardening
97546 Work hardening add-on
97601 Wound care selective
97602 Wound care non-selective
97703 Prosthetic checkout
97750 Physical performance test
97799 Physical medicine procedure

CPT codes, descriptors and other data are copyright 2001 American Medical Association (or such other date of publication of CPT



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