Medical Supplies

• Consumable Medical Supplies Policy
• Standard Plan Language Exclusions
• Definition
• Reimbursement Policy
• Managed Care Guidelines

Consumable Medical Supplies Policy

Consumable medical supplies are covered in conjunction with:

• inpatient hospital services;
• outpatient hospital facility services;
• home health services;
• diabetic services;
• breast reconstruction and breast prostheses.

Note:

• State or federal legislation and/or plan-specific language supercede CIGNA HealthCare's administrative coverage policies.

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Plan Exclusions

Most plans contain exclusions for consumable medical supplies. Although plan language varies considerably, a typical exclusion defines consumable medical supplies as including, but not limited to, bandages and other disposable medical supplies, skin preparations and test strips.

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Definition

Consumable medical supplies are non-durable medical supplies that:

• are usually disposable in nature;
• cannot withstand repeated use by more than one individual;
• are primarily and customarily used to serve a medical purpose;
• generally are not useful to a person in the absence of illness or injury;
• may be ordered and/or prescribed by a physician.

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• Consumable Medical Supplies should be billed using the applicable HCPCS code(s).
• Casting & Splint Supplies (Q4001-Q4051) are payable in addition to other services billed on the claim.
• Durable Medical Equipment: Consumable medical supplies provided in conjunction with DME are covered if the supplies are necessary for the function of the equipment and the equipment is covered under the plan.
• Diabetic Supplies
1. Claims for insulin needles and syringes (A4206, A4207, A4208, A4209, A4215) will be paid under the member's benefit plan, either medical or pharmacy.
2. Claims for lancets (A4258 and A4259) will be denied as consumable supplies, unless covered under state mandate or pharmacy rider.
3. Claims for glucose test strips (A4772, A4253) will be denied as consumable supplies, unless covered under state mandate or pharmacy rider.
4. Claims for glucometer devices (E0607, E0609) will be paid under the DME benefit.
• Surgical Trays: Surgical trays are considered reimbursable for select procedures.
• Oxygen and Oxygen Delivery Systems/Supplies: Oxygen and Oxygen Delivery Systems/Supplies are not considered consumable supplies or DME. They are considered under a member's medical benefit.
• Breast Reconstruction and Prostheses: Breast prostheses are covered under the EPA benefit. Mastectomy bras are covered following a mastectomy under a member's medical benefit.

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Managed Care Guidelines

• Consumable medical supplies can be allowed under the lead referral/precertification for the associated services.
• Ostomy supplies are covered.
• If consumable medical supplies are not provided in conjunction with authorized or referred services, and are not covered under the plan for benefits, they will not be reimbursed by CIGNA HealthCare.

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