Medicare coverage of driveline kits for ventricular assist devices (VADs)

Maintenance supplies and replacement components for cardiac left ventricular assist devices (VADs) are covered under the Medicare Part B benefit. These items are considered medically reasonable and necessary for the safe functioning and ongoing maintenance of the device.

Driveline kits often contain supplies for care of the VAD driveline connecting the device inside the body to the external controller. The list of standard driveline kit items is as follows: gloves, mask, Chloroprep, bio-patch, alcohol pads, betadine pads, gauze dressing, and Foley anchor. The kits contain the appropriate amount of items for the typical patient with a VAD for the duration of time specified in the kit. First Coast will cover driveline kits when ordered as a daily, weekly, or monthly supply.  However, when driveline kit items are ordered individually and billed to Medicare, they will be denied as not medically reasonable and necessary.

When individual items are ordered in addition to the driveline kit and billed to Medicare, they will also be denied as not medically reasonable and necessary but can be appealed when documentation supporting their medical necessity for the maintenance of the VAD is supplied.

Examples of additional supplies billed to Medicare in addition to the driveline kit include (w ga D224 (w/o ga) and D225): 

• 3M Tegaderm High Performance Adhesive Foam Dressing/ Aqua Guard Moisture
• Bioderm ungrip Securement Device medium Dual Strap/ Coloplast Brava Adhesive Remover Spray 1.7 oz bottle
• 3M Tegaderm Transparent Film Dressing Waterproof, Medicine Industries Ready Bath Premium Antibacterial washcloths latex free

Billing for additional VAD supplies

VAD dressing supplies are billed using HCPCS codes Q0507, Q0508 and Q0509. When billing for VAD supplies, the following information is required with the claim submission:

• Invoice for supplies / accessories provided
• List of supplies / accessories provided
  • Document whether individually packaged or in a kit (should also be noted on the invoice)

The invoice and list for supplies / accessories should be submitted via electronic submission of medical documentation (esMD) or paperwork (PWK), using the Part A PWK fax / mail / esMD coversheet or Part B PWK fax / mail / esMD coversheet.

Claims for VAD supplies MUST have documentation

Note: Claims received without the required information listed above will be rejected.

The following information must be maintained in the patient’s medical record and be available upon request:

• Physician’s order for supplies / accessories listing frequency and duration of its use
• Office / progress notes for the patient documenting the presence of a VAD device