Durable Medicaid Equipment, Prosthetics, Orthotics, and Supplies DMEPOS Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider types. Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS) 01/2017 This manual has information specific to your provider type. Provider Manuals – Replacement Pages General Information for Providers 02/06/2017 In summary, the Telemedicine Chapter was added as a new chapter. And the Medically Needy section of the Member Responsibilities Chapter page 6.5 was updated. 01/30/2017 In summary the scale exception was removed on page 3.18, the date on the cover was updated, and basic accessibility modifications were made to the entire manual. 08.02.2016 The Introduction contains updated links in the HELP section. Cost Share was updated in the Billings Procedure. A duplicate word was removed in the RA chapter. The Cover Page was changed to reflect the current date of the new General Manual revision. 07.12.2016 General Information For Providers, July 2016 Table of Contents was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Index was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Page 1.3 changed the title “Basic Medicaid Waiver for Additional Services and Populations” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)” 01.19.2016 General Information for Providers, January 2016: Introduction Regarding HELP Plan Information 01.15.2016 General Information for Providers, January 2016: Introduction Regarding HELP Plan Information 12.31.2015 General Information for Providers, January 2016: HELP Plan-Related Updates and Others 11.17.2015 General Information for Providers, November 2015: Billing Procedures, Revenue Codes 25X and 27X 07.31.2015 General Information for Providers, August 2015: Entire Manual; Added EPSDT Well-Child, Removed Passport 11.19.2014 General Information for Providers, November 2014: Billing Procedures 10.08.2014 General Information for Providers, September 2014: Billing Procedures 07.22.2014 General Information for Providers, July 2014: Member Eligibility and Responsibilities 06.30.2014 General Information for Providers, June 2014: Entire Manual If information is found on the website, it has been removed from the manual, and a link to the source is provided. 04.13.2012 General Information for Providers, April 2012: Medicaid Covered Services and Client Eligibility 04.29.2005 General Information for Providers, April 2005: Member Number a Billable Number and Key Contacts Updated 11.05.2004 General Information for Providers, November 2004: References to Medicaid Rules. and Regulations Added 09.16.2004 General Information for Providers, September 2004: Team Care and Nurse First Information Added DMEPOS 07.28.2016 DMEPOS, July 2016: In summary, the Hospital Grade Breast Pump section was updated in the Covered Services chapter, and the Table of Contents and Index was changed to reflect impacted page numbers. 06.20.2016 DMEPOS, July 2016: In summary, date only was amended on the cover, and the How Payment is Calculated section was updated to reflect the current cost share amount. 12.31.2015 DMEPOS, January 2016: HELP Plan-Related Updates and Others 09.01.2015 DMEPOS, August 2015: URL Updates and Covered Services 04.24.2015 DMEPOS, April 2015: Covered Services, Billing Procedures, and Appendix A: Forms 11.19.2014 DMEPOS, November 2014: Entire Manual The entire manual has been streamlined; sections that include text changes are noted with black bar in margin. 11.15.2013 DMEPOS, October 2013: Entire Manual These replacement pages also includes a terminology change (client to member). Unless a paragraphs also included content changes, it is not marked as a change but is included in this document. 07.26.2012 DMEPOS, July 2012: Appendix A: Forms 06.14.2010 DMEPOS, June 2010: Covered Services 11.26.2008 DMEPOS, June 2008: Covered Services 03.05.2008 DMEPOS, September 2007: Covered Services and Submitting a Claim 04.07.2005 DMEPOS, April 2005: Removed CPAP CMN 01.21.2005 DMEPOS, January 2005: Apnea Monitor PA Requirements Medicaid Rules and Regulations Code of Federal Regulations (Title 42) Montana Code Annotated (Title 53, Chapter 6) Administrative Rules of Montana (Title 37) Chapter 79 Healthy Montana Kids Chapter 82 Medicaid Eligibility Chapter 83 Medicaid for Certain Medicare Beneficiaries and Others Chapter 85 General Medicaid Services Chapter 86 Medicaid Primary Care Services 11/19/2014 General Information for Providers 11/19/2014 Billing Procedures 10/08/2014 Billing Procedures 07/22/2014 Member Eligibility and Responsibilities 06/30/2014 General Information for Providers If information is found on the website, it has been removed from the manual, and a link to the source is provided. 04/13/2012 Medicaid Covered Services and Client Eligibility 04/29/2005 Member Number a Billable Number and Key Contacts Updated 11/05/2004 References to Medicaid Rules/Regulations Added 09/16/2004 Team Care and Nurse First Information Added DMEPOS 11/19/2014 Entire Manual The entire manual has been streamlined; sections that include text changes are noted with black bar in margin. 11/15/2013 DMEPOS Manual These replacement pages also includes a terminology change (client to member). Unless a paragraphs also included content changes, it is not marked as a change but is included in this document. 07/26/2012 Appendix A: Forms 06/14/2010 Covered Services 11/26/2008 Covered Services 03/05/2008 Covered Services and Submitting a Claim 04/07/2005 Removed CPAP CMN 01/21/2005 Apnea Monitor PA Requirements Prescription Drug Program 09/27/2013 Reimbursement 09/05/2013 Entire Manual Including the New Passport Chapter This set of replacement pages contains a terminology change ("client" to "member"); however, only content changes are marked with a change bar (black line). 04/17/2013 Key Contacts and Reimbursement 02/04/2013 Medicaid Covered Products 02/01/2012 Multiple Chapters 09/01/2011 Medicaid Covered Services and Reimbursement (Dispensing Fee) and MHSP Covered Products (Formulary Drugs) 06/17/2011 Prescription Drug Services (entire manual) 11/16/2004 Prescription Drug PA Criteria 06/16/2004 PA and HIPAA Updates Fee Schedules – Durable Medical Equipment (DME) PDF Excel 08.27.2015 July 2015 DME Rev. 08.27.2015 July 2015 DME Rev. 03.10.2015 January 2015 DME Rev. 03.10.2015 January 2015 DME Rev. 10.2014 October 2014 DME Rev. 10.2014 October 2014 DME Rev. 07.2014 July 2014 DME 07.2014 July 2014 DME 02.2014 January 2014 DME 02.2014 January 2014 DME 07.2013 July 2013 DME 07.2013 July 2013 DME 01.2013 January 2013 DME 01.2013 January 2013 DME 01.2012 January 2012 DME 01.2012 January 2012 DME 07.2011 August 2011 DME 07.2011 August 2011 DME 01.2011 January 2011 DME 01.2011 January 2011 DME 01.2010 January 2010 DME 01.2010 January 2010 DME 07.2009 July 2009 DME 07.2009 July 2009 DME 01.2009 January 2009 DME 01.2009 January 2009 DME 01.2008 January 2008 DME 01.2008 January 2008 DME 07.2007 July 2007 DME 07.2007 July 2007 DME 01.2007 January 2007 DME 01.2007 January 2007 DME 11.2006 November 2006 DME 11.2006 November 2006 DME 07.2006 July 2006 DME Updated 10.2006 07.2006 July 2006 DME Updated 10.2006 01.2006 January 2006 DME 01.2006 January 2006 DME 01.2005 January 2005 DME Updated 12.2005 01.2005 January 2005 DME Updated 12.2005 01.2004 January 2004 DME 01.2004 January 2004 DME 07.2003 July 2003 DME 07.2003 July 2003 DME 02.2003 February 2003 DME 02.2003 February 2003 DME 07.2002 July 2002 DME 07.2002 July 2002 DME 01.2002 January 2002 DME 01.2002 January 2002 DME Provider Notices 2010–2017 2016 01/11/2017 New HCPCS Codes for Insulin Pump Supplies – A4224 & A4225 11/10/2016 Insulin Pump PA Removal 09/26/2016 Coverage of Weighted Blankets 07.18.2016 Changes to Member Cost Share Update 05.19.2016 Changes to Member Cost Share 04.07.2016 Montana Plan First - IUD and Anesthesia Updates 03.21.2016 HCPCS Code For Ventilators E0465 and E0466 02.01.2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit 01.15.2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01.19.2016 01.15.2016 Hospital Grade Electric Breast Pump Requirements 2015 12.31.2015 Changes to Montana Medicaid 11.27.2015 Home Blood Glucose Monitors and Related Accessories and Supplies 11.13.2015 Oral Nutrition for Children Under Age 21 – EPSDT 11.03.2015 Services Exempt from Passport to Health Referral 10.01.2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual 08.03.2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) 07.31.2015 Adult and Pediatric Specialty Table of Services Available in Montana 06.22.2015 Identification of Ordering and Referring Providers on CMS-1500 and 837P X12 Transactions 04.27.2015 Children’s (EPSDT) Coverage Criteria for Specified DME 02.11.2015 New HCPCS Modifiers – XE, XP, XS, and XU 2014 12.18.2014 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Notice 12.08.2014 Compression Garments for the Legs 11.24.2014 DME Order and Prescription Requirements 11.05.2014 Gastrostomy/Jejunostomy Tube – Code B4088 09.16.2014 Adoption of the New Children's Mental Health Bureau's Medicaid Provider Manual into Administrative Rules of Montana 08.05.2014 Montana Prescription Drug Registry 08.05.2014 Montana Prescription Drug Registry 07.14.2014 Home Blood Glucose Monitors and Related Accessories and Supplies 06.26.2014 Terminology Change Regarding Method of Payment 06.24.2014 HMK (Formerly CHIP) Diabetic Supplies 06.12.2014 ICD-10 Delay 05.13.2014 PERM Provider Educational Webinars 04.22.2014 Modifier Changes for Professional Claim Billers 03.27.2014 Home Blood Glucose Monitors and Related Accessories and Supplies Update 03.18.2014 Information Regarding CMS-1500 01.29.2014 Centers for Medicare and Medicaid Services (CMS) ICD-10 Provider Readiness Assessment Update 01.09.2014 Using Medicaid Card ID Number When Billing and Checking Eligibility 01.09.2014 Reimbursement Changes for Covered Ancillary Services Provided to Youth in a PRTF and Additional Information Pertaining to PRTF Services 2013 12.23.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update 11.26.2013 ICD-10 Readiness 10.28.2013 Mail Order Diabetic Testing Supplies 10.11.2013 Automatic Blood Pressure Monitor (A4670) 09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes 07.01.2013 Home Blood Glucose Monitors and Related Accessories and Supplies See 03.27.2014 Update 05.28.2013 DPHHS to Discontinue Temporary Hotline Number 05.20.2013 T4535 – Underpads, Liners, and Shields 04.01.2013 Home Blood Glucose Monitors and Related Accessories and Supplies 04.01.2013 Wheelchair Replacement of Equipment 04.01.2013 Standing Tables (Standing Frames) 02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade 2012 12.26.2012 Medicaid/HMK Plus Toll-Free Number 12.26.2012 Home Oxygen Therapy for Clients Residing in Skilled Nursing Facility 08.22.2012 Deleted ICD-9-CM Codes 03.21.2012 Durable Medical Equipment Coverage for Clients with Basic Medicaid Only 03.21.2012 01.06.2012 Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Start Date Must Match Admission Date 2011 11.07.2011 Provider Information on HIPAA 5010 837 Health Care Claim Transactions 09.09.2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012 09.09.2011 DME Order and Prescription Requirements 09.07.2011 Payment Error Rate Measurement (PERM) 08.24.2011 Billing of Miscellaneous Code B9998 07.18.2011 Reimbursement Changes for Covered Ancillary Services Provided to Youth in a PRTF and Additional Ancillary Services Are Covered 06.27.2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012 06.24.2011 Prior Authorization for Rental of Electric Hospital Beds and Bone Growth Stimulators 04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011 2010 10.05.2010 Changes to NCCI Edits 07.28.2010 Provider Record Update Procedures 06.23.2010 Cost Sharing Exemption Under ARRA 06.22.2010 Electronic Health Records Link 02.09.2010 United States 2010 Census 01.21.2010 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers Provider Notices 2002–2009 2009 10.07.2009 Quantity Limits on Ostomy Products 10.01.2009 Healthy Montana Kids Plan 03.16.2009 Timely Filing for Medicare Crossovers 03.09.2009 Screening Criteria for Equipment (Mobility Devices, Shower Chairs, Bathing Systems, Standers) 03.09.2009 Screening Criteria for Combination Shower Commode Chairs and Accessories 03.09.2009 Medicaid Policy on 36-Month Oxygen Cap 03.09.2009 Revised Limits for Incontinence Products Updated 03.10.2009 02.12.2009 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers 2008 10.20.2008 Changes in Transplant Coverage 10.27.2008 08.12.2008 Federal Government May Request Medical Records 09.18.2008 06.09.2008 Billing and Policy Changes 08.11.2008 05.22.2008 Frequently Asked Questions About NPI Reenrollment and Billing 06.17.2008 04.14.2008 New Codes for Disposable and Reusable Incontinence Products 03.25.2008 New Rules Effective January 1, 2008 03.25.2008 Durable Medical Equipment Coverage for Clients With Basic Medicaid Only 03.17.2008 Resubmission of Denied Claims 03.19.2008 03.10.2008 NPI Reenrollment and Billing 01.18.2008 Possible Duplicate Claims Processed Through Electronic Data Interchange 2007 12.17.2007 Enhanced Claims Editing – Assistant . Team . Co-Surgeon 12.17.2007 Enhanced Claims Editing – Multiple Evaluation and Management Services Provided on the Same Day 12.03.2007 NPI Requirement for Fee-for-Service Healthcare Provider Claims 11.27.2007 Cost Share Changes 11.01.2007 Enhanced Claims Editing – Add-On Codes 11.01.2007 Enhanced Claims Editing – New Visit Evaluation and Management Codes 11.01.2007 Enhanced Claims Editing Bloodhound ClaimsGuard® 08.29.2007 Criteria for Gait Trainers 08.29.2007 Criteria for Wheel Chair Seating in the Nursing Home 08.29.2007 Criteria for Group 2 Support Surface 08.01.2007 Elimination of eSOR 06.25.2007 NPI on the Web Portal 06.11.2007 Ownership and Control Information Required for Reenrollment 06.06.2007 NPI Contingency Plan Implemented, Reenrollment Extended 05.31.2007 New CMS-1500 to Be Required Beginning July 2, 2007 01.12.2007 Medicare Changes in Certificate of Medical Necessity (CMN) 01.12.2007 Revised Fee and Criteria on Phototherapy (Bilirubin) Light With Photometer 2006 12.22.2006 Prior Authorization for DMEPOS and Medical/Surgical Procedures Updated Phone and Fax Lines 11.08.2006 Prior Authorization on the Move 10.04.2006 Change in Reimbursement of the -QY Modifier 11.02.2006 Durable Medical Equipment Coverage for Clients With Basic Medicaid Only 10.10.2006 Separately Billable Supplies 07.24.2006 Capped Rental 05.17.2006 Coverage of Seat Lift Mechanisms 05.17.2006 Durable Medical Equipment Coverage for Clients With Basic Medicaid Only 2005 10.11.2005 Wheelchair CMNs – Transition Instructions 07.28.2005 Scales – Congestive Heart Failure 02.04.2005 Introduction to Preferred Drug List 2004 12.09.2004 Diaper/Incontinence Product Coding Changes 06.10.2004 Team Care Program A New Component of the Passport to Health Program 01.01.2004 January 2004 Fee Schedule Update 2003 08.29.2003 Passport to Health Implementation in Prairie County 08.29.2003 DMEPOS Advisory Workgroup Openings 08.20.2003 Submitting HIPAA Compliant Claims – Information for All Providers 07.07.2003 External Insulin Pump Requirements 07.02.2003 Electric Breast Pump Requirements 05.22.2003 Discontinued Services 05.12.2003 Provider Rate and Payment Update 03.03.2003 Coding and Reimbursement Revisions 03.01.2003 Deleted HCPCS Codes 02.28.2003 New Modifier BO 01.10.2003 New Provider Notification Procedure and Medicaid Changes 2000–2002 10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time 09.26.2002 DME Update 09.01.2002 Cost Sharing 07.01.2002 2.6% Reduction 03.21.2002 Prior Authorization Reminders: DME, DMEPOS 02.14.2002 Weekly Payment Available Other Resources EOB R&R Crosswalk PDF and EOB R&R Crosswalk Excel 02.2011 With the implementation of HIPAA, Medicaid discontinued the use of Medicaid EOB codes and began using HIPAA standard reason and remark (R&R) codes. This document crosswalks the HIPAA standard R&R codes to the Medicaid EOB codes. Noridian Administrative Services Medicare's DME Administrative Services provider. Prior Authorization Criteria for Specific Services Region D DMERC/CIGNA Medicare The Durable Medical Equipment Regional Carriers (DMERC) website. DMERC processes Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for Medicare. Medicare Pricing, Data Analysis, and Coding (PDAC) This website assists manufacturers and suppliers with DMEPOS billing and coding information. Can call toll-free 1-877-735-1326 or e-mail DME PDAC using their contact form. SURS Provider Self-Audit Protocol 10.2015 The TPL Carrier Code List has been removed from this website, for questions or concerns related to the document please contact firstname.lastname@example.org. Thank you.