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 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 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.