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DME|Supplies|Equipment - Articles

Medi-Cal Coverage Criteria for Hospital Beds and Accessories
November 7th, 2018 - Raquel Shumway
Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.
Capped Rental Items
October 26th, 2018 - Find-A-Code
CMS Gives guidance on Capped Rental Items: Items in this category are paid on a monthly rental basis not to exceed a period of continuous use of 13 months. Based on Supplier Standard 5, suppliers are required to advise beneficiaries of the rent/purchase option for capped rentals and inexpensive or routinely purchased items. ...
Home Oxygen Therapy -- CMN for Oxygen
June 14th, 2018 - Raquel Shumway
The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.
Preventive Medicine: Breastfeeding Supplies
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Breastfeeding Supplies Procedure Codes A4286: Locking ring for breast pump, replacement E0602: Breast pump, manual, any type E0603: Breast pump, electric (ac and/or dc), any type E0604: Breast pump, hospital grade, electric (ac and / or dc), any type S9443: Lactation classes, non-physician provider, per session ICD-10-CM ...
Coverage Criteria for Nonwearable Automatic Defibrillators
April 19th, 2018 - Find-A-Code
According to Noridian and CGS Administrators LCD L33690, a nonwearable automatic defibrillator (E0617) is covered for beneficiaries in two circumstances. They meet either (1) both criteria A and B or (2) criteria C, described below: The beneficiary has one of the following conditions (1-8):A documented episode of cardiac arrest due to ventricular fibrillation, not due to a ...
Documentation for Urological Supplies
March 9th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on required documentation for urological supplies.
Coverage for Power Tilt/Recline Seating Systems for Wheelchairs
March 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides coverage guidance for Power Tilt and/or Recline Seating Systems...
Preventing Denials for Lower Limb Prosthesis
March 8th, 2018 - Medicare Learning Network
The Medicare Learning Network provides guidance on denials for lower leg prostheses and how to prevent them: For the 2017 report period, most of the improper payments for lower leg prostheses were due to insufficient documentation. For Medicare to cover a lower limb prosthesis claim, the medical record must support the beneficiary’s ...
Preventing Denials for Manual Wheelchairs
March 8th, 2018 - Medicare Learning Network
The Medicare Learning network provides guidance on how to prevent denials for Manual Wheelchair Bases....
Preventing Denials for Therapeutic CGMs and Related Supplies
March 8th, 2018 - Medicare Learning Network
The Medicare Learning Network, provides coverage guidance on therapeutic CGMs and Related Supplies
CMS Changes Definitions for Therapeutic Shoe Inserts
February 1st, 2018 - Wyn Staheli, Director of Research
CMS recently revised their definitions for custom fabricated and therapeutic inserts in order to meet current technology standards. Healthcare providers need to be sure to review the revisions in order to appropriately bill Medicare for inserts. For example, for custom fabricated, molded-to-patient, they have added the following: iii. For inserts used with ...
Using Modifier EY
March 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Some Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items require a detailed Written Order Prior to Dispensing (WOPD), while others require a Detailed Written Order (DWO) prior to billing. The specific requirements for an order are specified in the Medical Policy (Local Coverage Determination and/or Policy Article) for the ...
Requirements for Physicians Orders for DME/HCPCS
March 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Effective July 1, 2013, certain DME/HCPCS codes require a valid detailed written order prior to delivery. There are very specific rules and requirements requiring medical necessity and orders/prescriptions. It is also required to keep a copy in the patients chart. If billing CMS and commercial payers payers, the DME prescribed ...

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