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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

07.12.2016

 

General Information For Providers, July 2016

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)

11/19/2014

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

04/21/2017 Bowl Management Program Supplies
04/17/2017 Prior Authorization for Insulin Pumps - E0784
04/06/2017 New EPSDT Request Form
03/31/2017  Ketone Test Strips - A4250 & A252
01/11/2017  New HCPCS Codes for Insulin Pump Supplies – A4224 & A4225

2016

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 mttpl@xerox.com. Thank you.

To locate older documents, access the Archive Page.