As originally asked by Martha Moyer.

Martha Moyer
Executive Director at Seth Moyer Support Microboard, Inc.
Thanks Amy for your advice on a product and a PDAC letter. I sent your comments on to the PIE people working on getting the products through Medicare.

Amy Dahl
Economic Support Specialist at Buffalo County Health & Human Services
Jacqueline Berry-Armstrong – Medicare does not Require any product to have a PDAC letter which is what you are speaking about with regards to getting a product approved for a specific code. It is completely voluntary not mandatory for a manufacturer to submit for coding approval on a particular product. You are correct in stating that it is a difficult and lengthy procedure for PDAC approval and that many products are not covered. I just ran across this webpage this morning that discusses the submission and approval process as well as the difference between a billable code and an approved code. [https://www.dmepdac.com/dmecs/index.html|leo://plh/https%3A*3*3www%2Edmepdac%2Ecom*3dmecs*3index%2Ehtml/7o6_?_t=tracking_disc]

Martha Moyer
Executive Director at Seth Moyer Support Microboard, Inc.
I have looked into colonics but the process is too expensive for the three times a week cleanouts my son needs .Getting to the place is inconvenient because of the need to travel to the site all the time. Colonics are often used for those who want to explore eating and drinking special things and then having the process done as sort of a party. These people can toilet themselves without help; although, I know a lady who has such constipation issues that she uses the process periodically but it is infrequently because she says it is expensive.The PIE helps those who can not toilet themselves at all and my son uses it at his home so it is always available when needed.

William Tiller
Officer at Tiller Mind Body Inc.
Please go to internet and click on colonic.net . This the most important . Their is a better way .

Martha Moyer
Executive Director at Seth Moyer Support Microboard, Inc.
Jacqueline: This machine has lasted for over ten years now and it is still going and going. It is a very well built machine and certainly not like compression stockings. Why do they cover dialysis machines in the home? This machine is made as good as those and I believe is probably as lasting or more lasting.
My son has bowel muscles that are shot. He can not push feces out. Enemas do not work because the feces gets stuck in the upper bowel where enemas can not reach. That is why this machine is so good because it pulsates up into the upper bowel so the whole elimination is done properly. PIE has been successful recently in getting Florida Medicare to cover and a California Medicaid dealer is working to help. I am hopeful.
Thanks for your reply. I will forward the message on to PIE.

Jacqueline Berry-Armstrong
Owner at Physician Medical Supply Inc
medicare Medicaid have NOT paid for many things for many years it is up to the manufacturer to present information to obtain a code… this is a very complicated process where many have failed it takes a lot of money hiring a consultant who knows how to work the system to obtain a “code” for your product which is how the medicare billing system works Medicaid and many private insurances follow medicare guidelines also this sounds more like a pharmacy type of preparation not a machine for medicare to cover durable medical equipment it means by definition durable lasts more than 12 months you could also try the fda and try to determine the process to obtain what they call a “j” code for enteral nutrition sorry I cant be more optimistic for you medicare does not cover compression stockings because they only last 6 months and used to be inexpensive less than 100.00 unfortunately now if they are custom they can now cost several hundred dollars and still no coverage and really if something is “not covered” it doesn’t really matter what the doctor orders they still wont pay for it

Martha Moyer
Executive Director at Seth Moyer Support Microboard, Inc.
I read that years ago. Thanks for resending it. For some reason, years ago the PIE people were having more luck with insurance and, what I am told, is they sort of let down on their efforts. Years ago they would send out a representative when someone bought a machine but in later years tried to help people just over the phone. This is what we faced when I took over in 2010 and found the machine not working due to a bent over fuse, which a friend with electrical skill easily fixed with another bought down the street at Radio Shack. But, because my son had been in another agency that didn’t want to pay for the treatment, apparently, well I discovered that there had not been any distribution of disposables since five years prior. The health of my son had quickly deteriorated and all staff had to be hired anew including a nurse to do the treatment. The Lord came through with a great nurse who has been on board ever since, but thank goodness I am able now to pay for the supplies but with such small funding it really hurts. I really think that for five years the agency had not obeyed the doctor’s orders. You should have seen the difference in the looks of my son with the PIE started up again. Almost immediately his health improved and his whole body morphed into that of a healthy man.

Jean Bigoney, RAC, CQE
Regulatory Affairs Specialist.
Well Martha it sound like you are fighting the good fight and indeed are way ahead of me. If it helps at all here is the document from BCBS Alabama which has some hard facts and what looks to me to be clear thinking on the subject.
[https://www.bcbsal.org/providers/policies/final/049.pdf|leo://plh/https%3A*3*3www%2Ebcbsal%2Eorg*3providers*3policies*3final*3049%2Epdf/omTD?_t=tracking_disc]

Martha Moyer
Executive Director at Seth Moyer Support Microboard, Inc.
Thanks Jean: I am way ahead of you regarding going to the state agency, congressman and there is absolutely not help there. It seem they feel this is all recreational colonics…people drink special juices and special cleansing products because they feel it will clean a dirty bowel. These people are all health nuts and are able to toilet themselves fine. This is not the case of my son whose bowels are completely nonfunctional. I have a Cal. distributor working on this matter. She has tried to run it through an old code when the device was OK’d but has been denied again because of the thinking on colonics. I even looked into getting this through my becoming a Medicaid provider but found out there was no applicable code and Texas requires all business to have a physical presence. That was out for me. I appreciate your ideas and willingness to help.

Jean Bigoney, RAC, CQE
Regulatory Affairs Specialist.
Martha I am sorry to hear that you are having problems.

I took a quick look and it appears that this product is coded with E0350 )Control unit for electronic bowel irrigation/evacuation system) and E0352 (Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system).

A search of the Noridian Codes, however, did not turn up any products in this code. This could have a number of reasons, for example PIE Medical has not submitted a “coding verification request” or they could have done so prior to this information being entered into the database.

It is therefore unclear to me is whether this is a coding issue (PIE Medical does not have their products in the system) or a coverage issue (the PIE Medical products are coded as E0350/E0352, but for some reason coverage is being denied.

I do note that Aetna (private) considers it investigational and will not cover it
([http://www.aetna.com/cpb/medical/data/500_599/0522.html|leo://plh/http%3A*3*3www%2Eaetna%2Ecom*3cpb*3medical*3data*3500_599*30522%2Ehtml/y7je?_t=tracking_disc] ). BCBS and a couple of state programs (for example California and North Carolina) will cover under certain conditions.

It may be worthwhile to get in touch with the state agency responsible for health care and see if they can help. Failing that you may want to call your congressmen and ask if they can put some heat on Medicare. Good luck!

Martha Moyer
Executive Director at Seth Moyer Support Microboard, Inc.
The name of the company I am talking about is PIE Medical www.piemed.com Right now they are supplying this young man directly from their company and they want a distributor to take over because it is not usual for a manufacturer to deal with a customer.

Martha Moyer
Executive Director at Seth Moyer Support Microboard, Inc.
I am a agency provider of services for an individual (happens to be my son) who is being denied DME Medical equipment that is needed to clean out his bowels because his bowels are paralyzed (don’t work at all…muscles won’t push) and a distributor and the DME company are trying to get Medicare (primary), private insurance or Medicaid to pay for the supplies and equipment. We keep getting denied because it is thought that such a procedure is just recreational and it is NOT. This young man must have this procedure to live just as people on dialysis must have it to live. The agency is using up a huge amount of its funds to keep this person alive.

Dave Rosenberg
✨ Perceptual Marketing & Branding ✨ I help you Interrupt how customers think and feel about your products and services ✨
A couple of clarifying questions: 1) Are you a distributor of DME? 2) Are you a manufacturer of DME that sells direct?