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TO:                 DURABLE MEDICAL EQUIPMENT (DME) VENDORS

 

FROM:           Paul Swatsenbarg, Deputy Administrator

 

   

Effective November 1, 2001, the following State-only codes will be deleted. National codes to use in place of State-only codes are provided below.

 

State Only HCPCS Codes to delete/crosswalk

 

State Only

Description

National HCPCS

Code Crosswalk

Price

0170E

Breast Pump, monthly

E0602

$395.34

0192E

Growth & Positioning System Wheelchair                        

K0108 – Must be prior authorized.

Manually priced – Please include description and invoice/MSRP documentation with claim.        

0351E

Toilet Rails, pair

E0243  (each)

$42.91 each

6772S

Enteral Supplies, NOC

B9998

Manually priced – Please include description and invoice/MSRP documentation with claim.

6628S

Parental Supplies, NOC

B9999

Manually priced – Please include description and invoice/MSRP documentation with claim.

 

Codes to be deleted without crosswalk, effective November 1, 2001

6780R              Underpads, full bed size, diaper service

6781R              Liner for mesh pant, diaper service

6782R              Mesh pant, diaper service

6783R              Full briefs X-lg, XX lg, diaper service

6784R              Full briefs Sm-Lg, diaper service

6785R              Active briefs, all sizes, diaper service

9770T              Wheelchair evaluation by DME vendor (included in purchase price of new
wheelchair) – Medicaid will no longer cover this code.

9771T              Wheelchair evaluation, motorized wheelchair (included in purchase price) – Medicaid will no longer cover this code.

9772T              Wheelchair custom seating system evaluation (included in purchase price) – Medicaid will no longer cover this code.

 

The proposed DME Rule will be published in the October issue of the Administrative Bulletin.

 

Remember to submit all medical necessity documentation when submitting a request. Refer to the DMERC Supplier Manual or the Medical Vendor Handbook for coverage criteria in order to determine what documentation to submit. Labor on a new wheelchairs is included in the allowable amount.  Pricing methodology on those codes that are manually priced is 75% of MSRP or cost +10%.  Those codes now include miscellaneous supply codes, such as A4649.

 

If you have questions regarding this Information Release, please contact a DME Specialist at

1-866-205-7403.

 

Thank you for your continued participation in the Idaho Medicaid Program.