by Jared Staheli
June 17th, 2015
Effective April 1, 1990, claims for rental of parenteral and enteral pumps are limited to payments for a total of 15 months during a period of medical need. Payment policies for these pumps generally follow the rules for capped rental items.
A period of medical need ends when enteral or parenteral nutrients are not medically necessary for 2 consecutive months.
Contractors do not allow additional rental payments once the 15-month limit is reached or pump is purchased unless the attending physician changes the prescription between parenteral and enteral nutrients.
Contractors do not begin a new 15-month rental period when a patient changes suppliers. The new supplier is entitled to the balance remaining on the 15-month rental period.
The supplier that collects the last month of rental (i.e., 15th month) is responsible for ensuring that the patient has a pump for the duration of medical necessity and for maintenance and servicing (M/S) of the pump during the duration of therapy.
A period of voluntary non-billing care and institutional care is not counted toward the 15 months. Calculation is resumed when the voluntary care ends or when the patient is released from institutional care.
An entire month's rent may not be paid when a patient is hospitalized during the month.
The contractor will request documentation to verify a break in medical need of two months or more before approving an additional 15-month rental period.
Contractors notify the supplier of the last rental payment.
The patient has the option of purchasing or renting the pump from the supplier. Contractors must request written authorization from the patient before or after paying for a pump purchase. If the patient decides to purchase the pump once rentals have been paid, the purchase allowance will consist of the used purchase allowance less the amount allowed to date for rentals.
Contractors provide coverage for one pump for parenteral nutrition. Contractors do not allow additional benefits for portable pumps or additional pumps.