CMS Simplifies Pessary Reimbursement Procedures

OB/GYN News, Oct 1, 2001 by Joyce Frieden

WASHINGTON - Getting reimbursed for providing pessaries to Medicare patients is about to get easier.

The Centers for Medicare and Medicaid Services has announced that, beginning Jan. 1, 2002, physicians can get reimbursed for pessaries through their local Medicare carrier. CMS' action came in response to physician concerns that the current processes were too cumbersome for doctors and patients.

Under current law, providers who wish to dispense pessaries in their offices must first obtain a supplier number-otherwise known as a Durable Medical Equipment Regional Carrier (DMERC) number. To get a number, physicians first must complete a several-page form. Once the DMERC number is issued, physicians are reimbursed through their regional DME carrier for any pessaries that they dispense.

If the physician does not have a DMERC number, the patient must be given a prescription for a pessary, fill the prescription at a pharmacy, come back with the pessary, and have the doctor insert it. The patient then must apply to Medicare for reimbursement for the pessary.

Under the new rule, doctors will no longer have to get a DMERC number. They will just insert the pessary and bill their carrier for the pessary and the procedure as they would for any other covered service.

Physicians insert pessaries in approximately 96,000 female Medicare beneficiaries each year; many of those patients have diabetes or other conditions that make surgical alternatives to a pessary a risky proposition.