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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) 05/2017

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 PDF July 2015 DME Rev. Excel July 2015 DME Rev.
03/10/2015 PDF January 2015 DME Rev. Excel January 2015 DME Rev.
10/2014 PDF October 2014 DME Rev. Excel October 2014 DME Rev.
07/2014 PDF July 2014 DME Excel July 2014 DME
02/2014 PDF January 2014 DME Excel January 2014 DME

Provider Notices

2017

06/05/2017 Pulse Oximetry for Children Age 0-20
05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
04/21/2017 Bowel 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

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

To locate older documents, access the Archive Page.