Correct Coding – Diathermy and Biofeedback Devices

Joint DME MAC Publication

Recently HCPCS coding verification reviews have been received for both diathermy and biofeedback devices used as part of inpatient or outpatient facility therapy but that are subsequently given to the beneficiary for use in the home. These items do not meet the payment requirements to be reimbursed as durable medical equipment (DME).

Diathermy and biofeedback therapies are addressed separately by National Coverage Determinations; NCD 150.5 for “Diathermy Treatment” and NCD 30.1 for “Biofeedback Therapy”. Both of these services are coded using Current Procedural Terminology (CPT) Codes. The equipment used in association with the provision of these services falls under the jurisdiction of the Medicare A/B Medicare Administrative Contractor (MAC). All diathermy and biofeedback devices are considered not separately billable to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) under the DME Benefit.

The Pricing, Data Analysis and Coding Contractor (PDAC) will assign the coding determination, “NO HCPCS CODE ASSIGNED” to diathermy and biofeedback devices submitted for review. A comment stating “NOT BILLABLE TO THE DME MACS” will be added to each diathermy and biofeedback device posted on the DMECS Product Classification List.

Devices not reviewed or not listed on DMECS must not be billed to the DME MAC. Claims submitted to the DME MACs for diathermy and biofeedback devices will be denied as wrong jurisdiction.

Manufacturers, distributors and suppliers should consult the Medicare A/B MAC contractor for correct billing of these devices.

For questions about coding verification reviews and correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/.