Enteral Billing

Billing Enteral Nutrition:

Number of Calories Prescribed ÷ 100 x Number of Days Billed = Number of Units

Example: Prescribed calories: 1500 per day for 30 days (one month), so 1500 Calories ÷ 100 x 30 Days = 450 Units for the month

If a physician orders more than one nutrient in the same category, the charges must be combined with the caloric units for these nutrients on one line. Each nutrien…t and the calories per day must be listed separately on the certification form.

Example: The certification indicates Osmolite at 750 calories per day and Ensure at 750 calories per day. Both nutrients are in the same category and should be coded as B4150, combined and submitted as follows: 1500 calories ÷ 100 x 30 Days = 450 Units for the month

Our Summary: Medicare will reimburse only for the number of calories ordered by the physician, divided by 100 and multiplied by the number of days supplied. Medicare will not reimburse for partial cans of unused product.

Information found on TeamDME website

On and after April 1, 2014, Medicare will no longer accept claims on the old CMS 1500 claim form. (Changes... 17. 21. & 24E)  MLN Matters Article 8509


https://www.noridianmedicare.com/dme/claims/cms1500_02-12_tutorial.html

Facebook Page DME Billing Guide

DME Billing Guide

Most billers know Medicare and most other insurance companies pay per unit for tape so make sure your converting your tape to total units on your claim. Most billing software will do this for you "IF" you set up your inventory item accurately.

A4450: Tape, non-waterproof, per 18 square inches

1" x 5 yds = 10 billable units per roll
5 x 3 x 12 x 1=180 square inches, devide by 18 = 10 units

2" x 10yds = 40 units (10x3x12x2=720
10 x 3 x 12 x 2 =720 square inches, devide by 18 = 40 units