CSHCN 2009 > Durable Medical Equipment (DME) > Benefits, Limitations, and Authorization Requirements

    
 

17.3.7.1 Authorization Requirements

Authorization is required. Documentation supporting medical necessity including, but not limited to, the presence of a gastrostomy (diagnosis code V441) must be submitted on the claim.

The following procedure codes must be used to submit claims for gastrostomy devices:

Procedure Codes

B4034

B4035*

B4036

B4081

B4082

B4083

B4087

B4088

* Procedure code B4035 is limited to a maximum of 31 per month by any provider. Providers may not bill a quantity greater than the number of days in the month for which they are submitting a claim. Claims with a quantity greater than the number of days in that month may be subject to a recoupment.

Refer to: Chapter 18, "Expendable Medical Supplies" for more information about related supplies and equipment.
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