Ob-Gyn Coding Alert

This January, two new HCPCS codes for a pessary A4561 (pessary, rubber, any type) and A4562 (pessary, non-rubber, any type) went into effect. Medicares 2001 fee schedule for durable medical equipment (DME) includes allowables for the two new codes. To access a copy of the entire fee schedule, go to the HCFA Web site at www.hcfa.gov/stats/pufiles.htm, and scroll down to the heading Payment Rates Non-Institutional Providers, then click on file DME01_A.exe or DME01_A.zip to download the fee schedule.

Most ob/gyns will report A4562 (as it is for a silicone pessary), which will pay from $44.25 to $53.11 according to the fee schedule, depending on the state. The payment ceiling was established at $54 and the floor at $40.50.

The breakdown by area is as follows:

$44.25: Ark., Ariz., Calif., Conn., Washington D.C., Del., Hawaii, Idaho, Mass., Md., Maine, N.H., N.J., Nev., N.Y., Ore., Pa., R.I., Va., Vt., Wash., W.Va.
$45.11: Kan., Mo., Neb., Iowa
$45.34: Ill., Ind., Mich., Minn., Ohio, Wis.
$45.57: Ala., Ark., Fla., Ga., Ky., La., Miss., N.C., N.M., Okla., S.C., Tenn., Texas
$45.82: Colo., Mont., N.D., S.D., Utah, Wyo.
$53.11: Puerto Rico, U.S. Virgin Islands