ARCHIVED

Medical Policy

Policy Num:       01.002.005
Policy Name:     Materials or Surgical Medical Supplies
Policy ID:          [1.002.005x][Ac L M P ][0.00.00]

Last Review:       November 11,2020
Next Review:       Policy Archived
Issue:                  11:2020

Related Policies:

None

ARCHIVED

Materials or Surgical Medical Supplies

SUMMARY

Medical supplies that, due to their diagnostic or therapeutic characteristics, are essential for the effectiveness of the care plan ordered by the doctor for the treatment or diagnosis of the patient's illness or injury.

OBJECTIVE

Medical supplies are request for the treatment or diagnosis for the patient injury or illness.

POLICY STATEMENTS

Surgical medical supplies or materials are considered for payment if they meet the following criteria.

• Items whose primary function is to serve a medical purpose.

• Are ordered and documented as essential in the patient's care plan.

• They are not necessary in the absence of illness or trauma.

• They are disposable items.

Examples of these materials or supplies are, but not limited to:

1. sterile gloves, eye patches, sterile solutions

2. lines for IV, bandages for wound care

3. sterile gauze, urinary catheter (foley), nasogastric

4. colostomy bag, gloves and nasotracheal suction catheter

POLICY GUIDELINES

Medical-surgical materials or supplies not covered are those:

1. Of routine use in the home

2. Not designated for a specific patient

3. Not related to illness or injury under the care and guidelines of a doctor: Examples of supplies not covered;

Izopos (applicators)

Hygiene items

Alcohol preps.

Skin conditioners

Plasters

Robes

Cotton

Samples packaging

Tongue depressants

Thermometers

More expensive

BENEFIT APPLICATION

BlueCard/National Account Issues

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BACKGROUND

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REGULATORY STATUS

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RATIONALE

Population Reference No. 1 Policy Statement

Individuals are request Medical Supplies for the treatment or diagnosis for the patient injury or illness.

SUPPLEMENTAL INFORMATION

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PRACTICE GUIDELINES AND POSITION STATEMENTS

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MEDICARE NATIONAL COVERAGE

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REFERENCES

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CODES

APPPLICABLE MODIFIERS

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POLICY HISTORY