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24.3.13 Gastrostomy Devices
Low-profile gastrostomy devices are a benefit of the CSHCN Services Program when prescribed by a physician. Authorization is required. Documentation supporting medical necessity (i.e., presence of gastrostomy, diagnosis code V441) must be submitted with the claim.
Physicians, pharmacies, medical suppliers, and home health agencies may be reimbursed for nonobturated gastrostomy devices. Only physicians may be reimbursed for obturated gastrostomy devices. Two devices may be reimbursed per calendar year. Additional devices may be reimbursed if documentation submitted with the claim indicates medical necessity, e.g., failure of device or infection at gastronomy site.
Other gastrostomy devices are not limited in quantity per year.Related supplies and equipment may be reimbursed as expendable supplies or durable medical equipment.
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