Retired - Correct Coding - Q9994 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH) Coverage Indicator Changed

Effective for dates of service on or after July 13, 2018, the Medicare coverage indicator administrative field has been changed for code Q9994 Healthcare Common Procedure Coding System (HCPCS) code Q9994 (IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH) was added to the Level II HCPCS code set effective July 1, 2018. This code describes products used in the administration of enteral nutrients. When new HCPCS codes are created, Medicare adds “administrative fields” to each HCPCS code to provide information necessary for claim processing by contractors.

The original administrative field for the coverage indicator was “I” which means “not payable by Medicare” for a claim to Medicare. The coverage indicator is being changed to “D” which means “special coverage instructions apply.” The coverage instructions arise from section 30.7.2 of the Medicare Claim Processing Manual (Internet Only Manual (IOM) 100-4), Chapter 20, “Payment for Parenteral and Enteral Nutrition (PEN) Items and Services.”

All existing Medicare coverage and payment rules, including the rules under section 30.7.2, continue to apply, and neither the code nor indicator change those rules. This change is effective for dates of service on or after July 13, 2018, and until further notice.

Refer to the Enteral Nutrition LCD, LCD-related Policy Article, and Standard Documentation Requirements article for additional information about coverage, coding, and documentation.