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April 6, 2017

Retired: DME Information Forms (DIFs) Usage for Enteral and Parenteral Nutrition and External Infusion Pumps - Revised

Joint DME MAC Publication

The DME MACs use DME Information Forms (DIF) when processing claims to assure the most current information is on file and to allow the claims to pay correctly. Claims for enteral and parenteral nutrition and external infusion pumps require a DIF to be submitted with the initial claim as well as when changes in the items or quantities provided are made. DIFs are completed entirely by the supplier and do not need to be signed by the treating physician. DIFs are required to be signed and dated by the supplier.

The following table indicates the DIFs for external infusion pumps and enteral/parenteral nutrition.

DME MAC FORM CMS FORM ITEMS ADDRESSED
09.03 10125 External Infusion Pumps
10.03 10126 Enteral and Parenteral Nutrition

Initial DIF:
A new Initial DIF is required when:

  1. An enteral formula billed with a different code, which has not been previously certified, is ordered; or,
  2. For either enteral formulas or administration via pump (B9002), there has been a break in billing of more than 60 days (plus the remaining days in the rental month) and there has been a change in the underlying medical condition that justifies coverage for the item(s).
  3. A beneficiary receiving enteral nutrition by the syringe or gravity method is changed to administration using a pump* (B9002).

*Change in method of administration from gravity or syringe to a pump (B9002) requires a new initial DIF for the pump and a revised DIF for the enteral nutrient (See chart below).

Revised DIF:

A Revised DIF is required when there has been a change in any of the information recorded on the DIF. The table below lists changes that require a Revised DIF to be submitted:

External Infusion Pumps
  • Changes in the existing drug HCPCS code
  • Substitution of drug HCPCS code for existing drug HCPCS code
  • Addition of drug HCPCS code
  • Change in the route of administration
  • Change in method of administration
  • Extend expired length of need
Enteral and Parenteral Nutrition
  • Change in HCPCS code for the current nutrient provided
  • Change (increase or decrease) in the calories prescribed
  • Change in the method of administration from gravity to syringe or syringe to gravity (See above for gravity or syringe to pump)
  • Change in the number of days per week of administration
  • Change in route of administration from tube feedings to oral feedings (if billing for denial)
  • When the length of need previously entered on the DIF has expired and the ordering physician is extending the length of need for the item(s)

The DIFs for External Infusion PumpsPDF and Enteral Nutrition or Parenteral NutritionExternal PDF can be located on each DME MAC web site.

For additional information, refer to the Supplier Manual, the applicable Local Coverage Determination and related Policy Article, and the Standard Documentation Requirements Policy Article.

Revision History

Article Retired: December 2018

Publication Date: April 2017
Revised: Clarifies that a Revised DIF instead of a Recertification DIF is required for Parenteral and Enteral Nutrition when the ordering physician extends length of need.
Deleted: HCPCS Code B9000, which was cross walked to HCPCS Code B9002

Publication Date: January 2017
Revised: Corrects a clerical error that at the end of the article, which inadvertently left the instructions for suppliers to obtain a recertification DIF for External Infusion Pumps when length of need expires and the ordering physician extends the length of need.

Publication Date: June 2015
Revised: A Revised DIF instead of a Recertification DIF is required for External Infusion Pumps when the ordering physician extends length of need.

Original Publication Date: January 2015

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