TO: Durable Medical Equipment (DME) Providers
FROM: Paul Swatsenbarg, Deputy Administrator
Policy Statement: C-PAP supplies are separately billable items that do not require prior authorization from the Department.
The Department met with several DME providers at the Big Sky Association meeting in September. During the discussion regarding Medicaid C-PAP policy, it was discovered the 2001 CIGNA Medicare DMERC supplier manual, which Medicaid adheres to, incorrectly listed that all C-PAP supplies were considered inclusive in the monthly rental price of the machine. The Department was directed to where the corrected information from DMERC was listed regarding separately billable supplies.
Idaho Medicaid will no longer consider C-PAP supplies inclusive within the rental price of a C-PAP machine for dates of service July 1, 2002. Supplies are now separately billable items that do not require prior authorization from the Department. Claims for C-PAP supplies for dates of service on or after July 1, 2002, which were previously denied, may be rebilled. Please remember that denied items are not adjustments and should therefore be billed to EDS the same as a new claim.
Medicaid would like to thank the Big Sky Association for their assistance to the Department.
Please direct all questions regarding this information to Colleen Osborn at 208-334-5795, ext. 16. Thank you for your continued participation in the Idaho Medicaid program.