Medicare Reimbursement FAQ

How is Hy-Tape® reimbursed under Medicare Part B?
Hy-Tape® is reimbursed the same way as any other type of tape. It is covered under the ostomy supplies and the surgical dressings policies established by the DMERCs. Like any other supply it must be medically necessary to be reimbursed.

What is the medical necessity for Hy-Tape® to be reimbursed by Medicare Part B?
Hy-Tape® may be medically necessary for a patient with an ostomy, a surgically created opening (stoma) to divert urine, feces or ileal contents outside the body. Hy-Tape® may also be medically necessary as a secondary dressing item to secure a wound cover, elastic roll gauze, or non-elastic roll gauze.

A wound cover and a secondary dressing item, such as Hy-Tape®, are covered when they are medically necessary:

  1. for the treatment of a wound caused by, or treated by, a surgical procedure; or
  2. when debridement of a wound is required.

What are the documentation requirements for reimbursement of Hy-Tape® under Medicare Part B?
The same documentation is required for Hy-Tape® as for any other type of tape. The order must include the type of supply (Hy-Tape®) and the approximate quantity to be used each month. An ICD-9 CM diagnosis code describing the type of ostomy or surgical wound must be included on the initial order to a supplier. A new order is required if there is a change in the quantity of tape used per month.

  1. For an ostomy supply: an order for Hy-Tape® must be signed and dated by the ordering physician and kept on file by the supplier.
  2. For secondary dressing item: an order for Hy-Tape® must be signed and dated by the patient’s attending physician, by a consulting physician for the condition resulting in the need for the tape, or by a Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife or Physician’s Assistant who is directly involved in the care of the patient. The order from a non-physician must be countersigned by the physician when required by State law and this order must be kept on file by the supplier.

Always consult your regional Supplier Manual for the exact medical necessity criteria and any other documentation requirements.

What is the HCPCS code for billing Hy-Tape® to the DMERCs?
The HCPCS code for billing Hy-Tape® to the DMERCs is A4452 (tape, all types, per 18 square inches).

What is the amount reimbursed by Medicare for Hy-Tape®?
Medicare reimburses for Hy-Tape® according to a fee schedule. Consult the DMERC fee schedule for your state to determine the exact amount. Deciding whether to accept assignment on claims submitted to Medicare Part B is an individual business decision. If you wish to charge and collect the full price for Hy-Tape®, you do not need to accept assignment.

What is the usual maximum quantity of Hy-Tape® allowed by Medicare Part B?
For an ostomy supply: the usual maximum quantity allowed is 2 rolls per month. Billing for Hy-Tape® is limited to a three-month supply at any one time for an ostomy patient at home.

For a secondary dressing item: the quantity of Hy-Tape® required should reasonably reflect the size of the wound cover being secured. Usual use for wound covers measuring 16 square inches or less is up to two units (36 square inches) per dressing change; for wound covers measuring 16 to 48 square inches, up to three units (54 square inches) per dressing change; and for wound covers measuring greater than 48 square inches, up to four units (72 square inches) per dressing change.

Is an ostomy patient ever allowed more than 2 rolls of Hy-Tape® per month?
The quantity of Hy-Tape® needed by a patient is determined by the type of ostomy, its location, its construction, and the condition of the skin surface surrounding the stoma. There will be variations according to individual need. The medical necessity for use of more than 2 rolls per month must be well documented in the patient’s medical record by the ordering physician.

Is Hy-Tape® reimbursed by Medicare in any other way?
If a Medicare certified home health agency supplies Hy-Tape® to a patient and bills it as medically necessary and essential to the treatment plan, it may be covered. In this case, Hy-Tape® may be used for any patient condition as long as it is included in the plan of treatment (Form 485-486). For example, it could be medically necessary to secure a wound dressing, a gastrostomy tube, an ostomy pouch, a fecal incontinence collector, an I.V., or for any other use as documented by the nurse and ordered by the attending physician.

Medical suppliers should contract with Medicare certified home health agencies to provide Hy-Tape® for their use. The agency then bills Medicare for their costs which is the initial cost of Hy-Tape® plus a mark-up, based on the expense of doing business.

Note that a prospective payment system for home health care is due to take effect in 1999. Under this payment method, home health agencies will receive a fixed payment amount per patient.

How is reimbursement for nursing home residents going to change?
Effective July 1, 1998, only skilled nursing facilities may receive payments for Medicare Part A and Part B products and services provided to their residents. Medicare will no longer make direct payments to Part B provider. The nursing facility is the only provider that will be eligible to receive Medicare reimbursement for supplies provided to a beneficiary. This means that nursing facilities will be required to bill for supplies, such as Hy-Tape®, currently billed by outside providers.