Medicare Reimbursement for NuLids (NuSight Medical)
FREQUENTLY ASKED QUESTIONS:
MEDICARE REIMBURSEMENT FOR NULIDS
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Q What is NuLids™?
A NuLids is an easy-to-use, battery-operated, mechanical hand piece to decap and stimulate Meibomian glands through reduction of biofilm and inflammatory mediators.
Q What are the indications for NuLids?
A NuLids is an at-home system for self-care to improve lid hygiene, particularly the removal of scale and debris on the eyelid margin associated with dry eye disease (DED) and blepharitis.
Patients with clogged Meibomian glands suffer from tear instability and accelerated tear evaporation which increases the symptoms of DED such as itching, stinging, redness, and foreign body sensation.
Q What are the results after using NuLids?
A Patients who used NuLids were surveyed regarding their satisfaction with the treatment. The results of the survey showed improvement in both the clinical presentation of the condition and the subjective patient responses to reduced symptoms.
Q How are patients’ subjective assessment of symptoms chronicled in the medical record?
A A questionnaire, such as the Ocular Surface Disease Index (OSDI)1 or Symptom Assessment iN Dry Eye (SANDE),2 is useful to assess and chronicle symptoms of chronic DED and blepharitis.
Q How does Medicare categorize NuLids for reimbursement?
A For the sake of reimbursement, NuLids is categorized as durable medical equipment (DME). According to CMS, “Durable medical equipment is equipment which: 1) can withstand repeated use; 2) is primarily and customarily used to serve a medical purpose; 3) is not useful in the absence of illness or injury; and 4) is appropriate for use in the home.” CMS further states, “Equipment is necessary when it can be expected to make a meaningful contribution to the treatment of the patient’s illness or injury or to the improvement of his or her malformed body member. In most cases the physician’s prescription for the equipment and other medical information available to the DME MAC will be sufficient to establish that the equipment serves this purpose.”
Q What HCPCS codes describe the instrument and the NuLids Daily Disposable Tips?
A HCPCS does not contain unique codes for NuLids. Use E1399 (durable medical equipment, miscellaneous) to report the instrument on a claim form, and A9999 (miscellaneous DME supply) to report the tips.
Q Does Medicare cover NuLids?
A Maybe. A determination of Medicare coverage and payment is the responsibility of the Durable Medical Equipment Medicare Administrative Contractor (DME MAC). A number of considerations inform this decision.
- Would the expense of the item to the program be clearly disproportionate to the therapeutic benefits which could ordinarily be derived from use of the equipment?
- Is the item substantially more costly than a medically appropriate and realistically feasible alternative pattern of care?
- Does the item serve essentially the same purpose as equipment already available to the beneficiary?
Physicians who are enrolled as Medicare suppliers, either as participating or nonparticipating, are obligated to file a claim and obtain a Medicare determination of coverage and payment.
Q Has a favorable coverage decision been made by any DME MAC?
A At present, there is no published Medicare policy for the NuLids System.
Q Can the ophthalmologist or optometrist who is not enrolled as a supplier be reimbursed by the DME MAC?
A No. If the DME MAC makes a favorable coverage and payment determination, the NuLids System would only be reimbursed if the ophthalmologist or optometrist is enrolled in Medicare as a DME supplier. If the physician is not enrolled as a Medicare supplier, the beneficiary is responsible for payment (even if the DME MAC issues a favorable coverage determination) provided that they agreed to accept financial responsibility prior to receiving the product.
Q How do we proceed if NuLids might not be covered by Medicare or the physician is not enrolled as a supplier?
A Physicians must follow the Medicare rules for billing non-covered items and services. In particular, there are “… rules for providing advance beneficiary notices (ABNs) that advise beneficiaries, before items or services actually are furnished, when Medicare is likely to deny payment for them. ABNs allow beneficiaries to make an informed consumer decision about receiving items or services for which they may have to pay out-of-pocket and to be more active participants in their own health care treatment decisions.”
1 Schiffman, RM, Christianson, MD, Jacobsen, G. Reliability and Validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000;118(5):615-621. Link here. Accessed 8/17/18
2 Amparo, F, Schaumberg, DA, Dana, R. Comparison of Two Questionnaires for Dry Eye Symptom Assessment: The Ocular Surface Disease Index and the Symptom Assessment iN Dry Eye. Ophthalmology 2015 Jul; 122(7): 1498-1503. Link here. Accessed 8/17/18
Provided Courtesy of NuSight Medical (833) 368-5437
The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, etc. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other
payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.
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