DME

Whenever there is a high-cost item, CMS has historically evaluated usage to determine appropriateness of billing and this is another example. A Decision Memo was released on February 15, 2018 which included the following changes:

Combined Deskbook Resources

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CMS has established a new prior authorization process for DMEPOS items that are frequently subject to unnecessary utilization.  The final rule will create an initial Master list that includes items that meet specific criteria.

Items already on the Master List that are identified by a GAO/OIG, or CERT DME and/or DMEPOS Service Specific Report(s) will remain on the list for 10 years from the publication date of the new report(s).

REMINDER: A prior authorization decision is not a payment decision, and thus a prior authorization decision is not appealable.

Supplies Resources (Resource 347)

Providing medical supplies to your patients can benefit both the patient and your practice. However, there are specific protocols that need to be followed in order to properly bill supplies. Not only do the proper codes need to be selected, but the appropriate use of modifiers is essential. Also, some payers have their own specific requirements that must be followed. For information on codes and modifiers, refer to Section I-Supply Codes of the Behavioral Health MultiBook.

Links:

Supply Codes

Q: Is there more specific codes for supplies rather than using 99070?

 

A: Yes. The HCPCS supply code series includes multiple more specific supply codes. The HCPCS supply codes are still too often overlooked and unused by providers. You will find that the HCPCS supply codes are more specific and as a result, often has more applicable codes for accurate reporting than the standard 99070 which is a non-specific, general supply code.

Joint DME MAC/PDAC Publication

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have evaluated the MyoPro® upper extremity assist device and determined that it falls within the Durable Medical Equipment (DME) benefit category. Claims for MyoPro® should be submitted using the DME miscellaneous code E1399.

In the case of collagen dressings coded A6021A6022

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