CMS Pub. 100-04, ch. 4, § 61.2

Reported With Device Codes and For Which Specific Devices are to be

Reported With Procedure Codes

(Rev. 3685, Issued: 12-22-16, Effective: 01-01-17, Implementation: 01-03-17)

The OCE will return to the provider any claim that reports a HCPCS code for a device-intensive procedure that does not also report at least one device HCPCS code required for

that procedure. If the claim is returned to the provider for failure to pass the edit, the

hospital will need to modify the claim by either correcting the procedure code or ensuring

that one of the required device codes is on the claim before resubmission. While all

devices that have device HCPCS codes and that were used in a given procedure should be

reported on the claim, only one of the possible device codes is required to be on the claim

for payment to be made, unless otherwise specified.

The device edit does not apply to the specified procedure code if the provider reports one

of the following modifiers with the procedure code:

52 - Reduced Services;

73 - Discontinued outpatient procedure prior to anesthesia administration; and

74 - Discontinued outpatient procedure after anesthesia administration.

Where a procedure that normally requires a device is interrupted, either before or after

the administration of anesthesia if anesthesia is required or at any point if anesthesia is

not required, and the device is not used, hospitals should report modifier 52, 73 or 74 as

applicable. The device edit is not applied in these cases.

The OCE will also return to the provider claims for which specified devices are billed

without the procedure code that is necessary for the device to have therapeutic benefit to

the patient. If the claim is returned to the provider for failure to pass the edit, the hospital

will need to modify the claim by either correcting the device code or ensuring that one of

the required procedure codes is on the claim before resubmission.