Wyoming Medicaid Provider Bulletin
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Wyoming Medicaid Provider Bulletin

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    Wyoming Medicaid Provider Bulletin Wyoming Medicaid Provider Bulletin Document Transcript

    • Medical Supplies 99.001 October 1, 1999 Wyoming Medicaid Provider Bulletin - Medical Supply Manual - Consultec Provider Field Representatives are available to make on-site visits to train your office staff on Medicaid billing procedures or to resolve claims payment issues. To set up an appointment for a Field Representative visit call: 777-5501 or 1 -800-251-1268 ALERT ALERT ALERT ALERT ALERT ALERT ALERT ALERT ALERT MEDICAL SUPPLY PROVIDER BULLETIN This bulletin contains important information regarding the new Medical Supply Manual for Medicaid enrolled Medical Supply Providers. Changes to policy and coding that are found in the new Medical Supply Manual will be effective October 1, 1999. Chapter Nine - gives general instructions for medical supply providers. This section outlines what the responsibilities of the provider are in regard to furnishing equipment and supplies. Reimbursement Guidelines are detailed in Chapter Nine, indicating what is included in the purchase or rental price of medical supplies and equipment. The Coverage Index - lists items that are covered by Wyoming Medicaid. If an item is not listed, providers may contact Consultec for coverage consideration. Documentation - Each type or piece of equipment requires specific documentation to be completed and on file by the medical supply provider. The various types of documentation are described in Chapter Nine. Please pay close attention to the section in Chapter Nine regarding “Written Orders”. This specifies what must be included in and the time limits on physician orders. 1
    • Medical Supplies 99.001 October 1, 1999 Providers must adhere to these guidelines in order to receive reimbursement. For many items, Wyoming Medicaid will no longer be requiring prior authorization. However, a new program for reviewing documentation in provider files, and examining equipment will be implemented in October of 1999. Definitions - The definitions given in Chapter Nine apply to the General Chapters and to the Coverage Index. Repair/Labor policy and pricing - The Coverage Index states the new policy for repair of durable medical equipment. Read it carefully. There is no reimbursement for routine maintenance. Ventilators - In general, back-up ventilators will now be included in the rental charge for the ventilator and will not be reimbursed separately. Miscellaneous codes - Bills submitted with miscellaneous codes will no longer be covered by Wyoming Medicaid unless prior authorization has been granted. Items covered by Wyoming Medicaid are listed in the Coverage Index. Unique requests will be reviewed by Consultec and forwarded to the durable medical equipment/medical supplies coordinator of Wyoming Medicaid for final review. Providers can request that Wyoming Medicaid cover items for which they are receiving frequent requests and there is no code available. Providers must submit written documentation of the following for consideration of coverage: 1. Description of the item; 2. Invoices from at least 2 manufacturers; 3. What item is used for; and 4. Number of requests providers have received. If Wyoming Medicaid determines coverage of an item is appropriate, a local code will be assigned. A local code will not be assigned for a one-time billing. Nutrition Section/form - This section has been revised in its entirety. Included in the coverage index you will find all reimbursement details for enteral and parenteral therapy and the infusion pumps. Also you will find reference to the Certificate of Medical Necessity for Parenteral Nutrition. This form can be located in Chapter Four. Please pay particular attention to the documentation and prior authorization requirements for Nutrition Therapy. 2
    • Medical Supplies 99.001 October 1, 1999 “K” Coding - Wyoming Medicaid is transitioning from using HCPCS “E” codes to HCPCS “K” codes. Providers must use “K” codes where appropriate in place of “E” codes. All covered “E” codes are included in the Medical Supply Manual. “K”Coding specific to wheelchairs - The following is a crosswalk of “K” codes to “E” and “Z” codes which have been replaced. “E” codes which do not have a corresponding “K” code have been retained (please refer to list following crosswalk). K0001 - Standard wheelchair E1130 Standard wheelchair, fixed full length arms, fixed or swing-away detachable footrests E1140 Wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1150 Wheelchair; detachable arms, desk or full-length, swing-away, detachable, elevating legrests E1160 Wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1221 Wheelchair with fixed arm, footrests E1222 Wheelchair with fixed arm, elevating legrests E1223 Wheelchair with detachable arms, footrests E1224 Wheelchair with detachable arms, elevating legrests K0002 - Standard hemi (low seat) wheelchair E1083 Hemi-wheelchair; fixed full-length arms, swing-away detachable, elevating legrests E1084 Hemi-wheelchair; detachable arms, desk or full-length, swing-away, detachable, elevating legrests E1085 Hemi-wheelchair; fixed full-length arms, swing-away, detachable footrests E1086 Hemi-wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests K0003 - Lightweight wheelchair E1240 Lightweight wheelchair; detachable arms, desk or full-length, swing-away, detachable, elevating legrests E1250 Lightweight wheelchair; fixed full-length arms, swing-away, detachable, footrests E1260 Lightweight wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1270 Lightweight wheelchair; fixed full-length arms, swing-away, detachable elevating legrests 3
    • Medical Supplies 99.001 October 1, 1999 K0004 - High-strength, lightweight wheelchair E1087 High-strength lightweight wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1088 High-strength lightweight wheelchair; detachable arms, desk or full-length swing-away, detachable, elevating legrests E1089 High-strength lightweight wheelchair; fixed-length arms, swing-away, detachable footrests E1090 High -strength lightweight wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests K0006 - Heavy-duty wheelchair E1092 Heavy duty, wide wheelchair; detachable arms, desk or full length, swing-away, detachable, elevating legrests E1093 Heavy duty, wide wheelchair; detachable arms, desk or full-length arms, swing-away, detachable footrests E1195 Heavy duty wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1280 Heavy duty wheelchair; detachable arms, desk or full-length, elevating legrests E1285 Heavy duty wheelchair; fixed full-length arms, swing-away, detachable, footrests E1290 Heavy duty wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1295 Heavy duty wheelchair; fixed full-length arms, elevating legrests K0008 - Custom manual wheelchair/base E1220 Wheelchair; specially sized or constructed K0010 - Standard-weight frame motorized/power wheelchair E1210 Motorized wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1211 Motorized wheelchair; detachable arms, desk or full-length, swing- away, detachable elevating legrests E1212 Motorized wheelchair; fixed full-length arms, swing-away, detachable, footrests E1213 Motorized wheelchair; detachable arms, desk or full-length, swing- away, detachable footrests K0013 - Custom motorized/power wheelchair base E1220 Wheelchair; specially sized or constructed K0016 - Detachable, adjustable height armrest, complete assembly, each 4
    • Medical Supplies 99.001 October 1, 1999 E0973 Adjustable height detachable arms, desk or full-length, wheelchair K0017 - Detachable, adjustable height armrest, base, each E0973 Adjustable height detachable arms, desk or full-length, wheelchair K0018 - Detachable, adjustable height armrest, upper portion, each E0973 Adjustable height detachable arms, desk or full-length, wheelchair K0019 - Arm pad, each E0994 Armrest, each K0021 - Anti-tipping device, each E0971 Anti-tipping device, wheelchair K0022 - Reinforced back upholstery E0976 Reinforced back, wheelchair, upholstery or other material K0025 - Hook-on headrest extension E0966 Hook-on headrest extension K0026 - Back upholstery for ultra lightweight or high-strength lightweight wheelchair E0993 Back upholstery K0027 - Back upholstery for wheelchair type other than ultra lightweight or high- strength wheelchair E0993 Back upholstery K0028 - Fully reclining back E1226 Full reclining back for customized wheelchair K0029 - Reinforced seat upholstery E0975 Reinforced seat upholstery, wheelchair K0030 - Solid seat insert, planar seat, single density foam E0992 Solid seat insert K0031 - Safely belt/pelvic strap E0978 Belt, safety with airplane buckle, wheelchair E0979 Belt, safety with Velcro closure, wheelchair K0032 - Seat upholstery for ultra lightweight or high-strength lightweight wheelchair 5
    • Medical Supplies 99.001 October 1, 1999 E0991 Upholstery seat K0033 - Seat upholstery for wheelchair type other than ultra lightweight or high- strength lightweight wheelchair E0991 Upholstery seat K0034 - Heel loop, each E0951 Loop heel, each K0036 - Toe loop, each E0952 Loop toe, each K0041 - Large size footplate, each E0970 No. 2 footplates, except for elevating legrest K0048 - Elevating legrest, complete assembly E0990 Elevating leg rest, each K0049 - Calf pad, each E0995 Calf rest, each K0055 - Seat depth of 15, 17, or 18 inches for a high strength, lightweight, or Ultra lightweight wheelchair E1297 Special wheelchair seat depth, by upholstery E1298 Special wheelchair seat depth and/or width, by construction K0056 - Seat height less than 17 inches or less than or equal to 21 inches for a high strength, lightweight, or ultra lightweight wheelchair E1296 Special wheelchair seat height from floor K0057 - Seat width 19 or 20 inches for heavy duty or extra heavy duty chair E1298 Special wheelchair seat depth and/or width by construction K0058 - Seat depth 17 or 18 inches for a motorized/power wheelchair E1297 Special wheelchair seat depth, by upholstery E1298 Special wheelchair seat depth and/or width, by construction K0062 - Hand rim with 8 to 10 vertical or oblique projections, each E0967 Wheelchair hand rims with eight vertical rubber-tipped projection, pair K0064 - Zero pressure tube (flat free insert) Z6524 Airless inserts 6
    • Medical Supplies 99.001 October 1, 1999 K0066 - Solid tire, any size, each E0996 Tire, solid, each K0067 - Pneumatic tire, any size, each E0953 Pneumatic tire, each K0074 - Pneumatic caster tire, any size, each E1000 Tire, pneumatic caster K0075 - Semi-pneumatic caster tire, any size, each E0954 Semi-pneumatic caster, each K0079 - Wheel lock extension, pair E0961 Brake extension, for wheelchair K0080 - Anti-rollback device, pair E0974 “Grade-aid” (device to prevent rolling back on and incline) for wheelchair K0082 - 22 NF deep cycle lead acid battery, each E1069 Deep cycle battery K0084 - Group 24 deep cycle lead acid battery, each E1069 Deep cycle battery K0088 - Battery charger, lead acid or gel cell E1066 Battery charger K0089 - Battery charger, dual mode E1066 Battery charger K0100 - Amputee adapter, pair E0959 Amputee adapter (device used to compensate for transfer of weight due to lost limbs to maintain proper balance) K0101 - One-arm drive attachment E0958 Wheelchair attachment to convert any wheelchair to one arm drive K0103 - Transfer board, less than 25 inches E0972 Transfer board or device K0107 - Wheelchair tray E0950 Tray 7
    • Medical Supplies 99.001 October 1, 1999 K0115 - Seating system, back module, posterior-lateral control, with or without lateral supports, custom fabricated for attachment to wheelchair base Z6526 Seating system Retained wheelchair “E” codes - The following “E” codes do not have a corresponding “K” code and may be submitted for reimbursement: E0962 One-inch cushion, for wheelchair E0963 Two-inch cushion for wheelchair E0964 Three-inch cushion for wheelchair E0965 Four-inch cushion for wheelchair E0968 Commode seat, wheelchair E0969 Narrowing device, wheelchair E0977 Wedge cushion, wheelchair E0980 Safety vest, wheelchair E0997 Caster with fork E0998 Caster without fork E0999 Pneumatic tire with wheel E1001 Wheel, single E1050 Fully reclining wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1060 Fully reclining wheelchair; detachable arms, desk or full-length, swing-away, detachable, elevating legrests E1065 Power attachment (to convert any wheelchair to motorized wheelchair e.g., Solo) E1070 Fully reclining wheelchair; detachable arms, desk or full-length, swing-arm, detachable footrests E1091 Youth wheelchair, any type E1100 Semi-reclining wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1110 Semi-reclining wheelchair; detachable arms, desk or full-length, elevating legrests E1170 Amputee wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1171 Amputee wheelchair; fixed full-length arms, without footrests or legrests E1172 Amputee wheelchair; detachable arms, desk or full-length, without footrests or legrests E1180 Amputee wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1190 Amputee wheelchair; detachable arms, desk or full-length, swing-away, detachable, elevating legrests 8
    • Medical Supplies 99.001 October 1, 1999 E1200 Amputee wheelchair; fixed full-length arms, swing-away, detachable footrests E1225 Semi-reclining back for customized wheelchair E1227 Special height arms for wheelchair E1228 Special back height for wheelchair Wheelchairs - Please note that all items in the wheelchair section require prior authorization. This process is being implemented to encourage thorough investigation into the needs of the recipient prior to purchase of a wheelchair. Stopped codes - The following is a list of HCPCS and local codes which will no longer be recognized by Wyoming Medicaid for billing or prior authorization purposes. The code(s) in parentheses represent an acceptable code(s) that may be used in place of the stopped code. A4575 Topical hyperbaric oxygen chamber A4630 Replacement batteries for medically necessary TENS, owned by recipient A4631 Replacement batteries for medically necessary electronic wheelchair owned by Recipient (K0082-87) A4421 Ostomy supply; miscellaneous A5149 Incontinence/ostomy supply; miscellaneous A6261 Wound filler dry form, per gram, NOC A6262 Wound filler, gel/paste, per ounce, NOC B9998 NOC for enteral supplies B9999 NOC for parenteral supplies E0273 Bed board E0274 Over bed table E0315 Bed accessory (table, board, etc.) E0430 Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannular or mask, and tubing (E0431) E0606 Postural drainage board E0635 Electric patient lift E0710 Restraint E0751 Implantable neurostimulator pulse generator or combination of external transmitter with implantable receiver (including extension) E0950 - Tray E0951 - Loop heel, each 9
    • Medical Supplies 99.001 October 1, 1999 E0952 - Loop toe, each E0953 - Pneumatic tire, each E0954 - Semi-pneumatic caster, each E0958 - Wheelchair attachment to convert any wheelchair to one arm drive E0959 - Amputee adapter (device used to compensate for transfer of weight due to lost limbs to maintain proper balance) E0961 - Brake extension, for wheelchair E0966 - Hood-on headrest extension E0967 - Wheelchair hand rims with eight vertical rubber-tipped projection, pair E0970 - No. 2 footplates, except for elevating legrest E0972 - Transfer board or device E0973 - Adjustable height detachable arms, desk or full-length, wheelchair E0974 - Anti-tipping device, wheelchair E0975 - Reinforced seat upholstery, wheelchair E0976 - Reinforced back, wheelchair, upholstery or other material E0978 - Belt, safety with airplane buckle, wheelchair E0979 - Belt, safety, with Velcro closure, wheelchair E0990 - Elevating leg rest, each E0991 - Upholstery seat E0992 - Solid seat insert E0993 - Back upholstery E0994 - Armrest, each E0995 - Calf rest, each E0996 - Tire, solid, each E1000 - Tire, pneumatic caster E1066 - Battery charger E1069 - Deep cycle battery E1083 - Hemi-wheelchair; fixed full-length arms, swing-away detachable, elevating legrests E1084 - Hemi-wheelchair; detachable arms, desk or full-length, swing-away, detachable elevating legrests E1085 - Hemi-wheelchair; fixed full-length arms, swing-away, detachable footrests E1086 - Hemi-wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1087 - High-strength lightweight wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1088 - High-strength lightweight wheelchair; detachable arms, desk or full-length swing-away , detachable, elevating legrests E1089 - High-strength lightweight wheelchair; fixed-length arms, swing-away detachable 10
    • Medical Supplies 99.001 October 1, 1999 footrests E1090 - High-strength lightweight wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1092 - Heavy duty, wide wheelchair; detachable arms, desk or full-length, swing- away, detachable, elevating legrests E1093 - Heavy duty, wide wheelchair; detachable arms, desk or full-length arms, swing- away, detachable footrests E1130 - Standard wheelchair; fixed full length arms, fixed or swing-away detachable footrests E1140 - Wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1150 - Wheelchair; detachable arms, desk or full-length, swing-away, detachable, legrests E1160 - Wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1195 - Heavy duty wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1210 - Motorized wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests E1211 - Motorized wheelchair; detachable arms, desk or full-length, swing-away, detachable, elevating legrests E1212 - Motorized wheelchair; fixed full-length arms, swing-away, detachable footrests E1213 - Motorized wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1220 - Wheelchair; specially sized or constructed E1221 - Wheelchair with fixed arm, footrests E1222 - Wheelchair with fixed arm, elevating legrests E1223 - Wheelchair with detachable arms, footrests E1224 - Wheelchair with detachable arms, elevating legrests E1226 - Full reclining back for customized wheelchair E1240 - Lightweight wheelchair; detachable arms, desk or full-length, swing-away, detachable, elevating legrests E1250 - Lightweight wheelchair; fixed full-length arms, swing away, detachable footrests E1260 - Lightweight wheelchair; detachable arms, desk or full-length, swing-away, detachable legrests E1280 - Heavy duty wheelchair; detachable arms, desk or full length, elevating legrests E1285 - Heavy duty wheelchair; fixed full-length arms, swing-away, detachable 11
    • Medical Supplies 99.001 October 1, 1999 footrests E1290 - Heavy duty wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests E1295 - Heavy duty wheelchair; fixed full-length arms, elevating legrests E1296 - Special wheelchair seat height from floor E1297 - Special wheelchair seat depth, by upholstery E1298 - Special wheelchair seat depth and/or width, by construction K0014 Other motorized/power wheelchair base L0999 Addition to spinal orthosis, not otherwise specified L1499 Spinal orthosis, not otherwise specified L2999 Lower extremity orthosis, not otherwise specified L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified L3999 Upper limb orthosis, not otherwise specified L5999 Lower extremity prosthesis, not otherwise specified L7499 Upper extremity prosthesis, not otherwise specified L8239 Gradient compression stocking, not otherwise specified L8499 Unlisted procedure for miscellaneous; prosthetic services L8699 Prosthetic implant, not otherwise specified X5005 Full equipment and patient evaluation and fitting for a wheelchair by a licensed PT, OT X5016 Ambu bag with pediatric mask X5017 Jay fluid mattress, Model 4000 or 4200 X5500 Ear or pulse oximetry reading (included in concentrator rental) X6500 Home management of ventilators, concentrators, oximeters, etc. Z0009 Extraordinary ventilator supplies Z0010 T-updraft nebulizer (K0168) Z0013 Disposable ambulatory pump, 100ml Z0014 Disposable ambulatory pump, 200 ml Z0015 Air purifier Z0016 Oxygen cannula/mask, for recipient owned equipment Z0017 Larger size pressure pad with attachment accessory for CPM Z0018 Artificial noses Z4188 TPN: compounded amino acids and carbohydrates Z4189 TPN: compounded amino acids and carbohydrates Z4190 TPN: compounded amino acids and carbohydrates Z4355 Parenteral nutrition administration kit bags, clips, extension sets, etc. Z4357 Suction tubing any size (K0192) Z4410 Bandages; eye bubble, per box Z4730 Humidifier Z4732 Breast pump (Z4733) 12
    • Medical Supplies 99.001 October 1, 1999 Z4734 Electric breast pump kit (Included in Z4733) Z6521 Reservoir cassette for parenteral pump - 50 ml (A4222) Z6522 Reservoir cassette for parenteral pump - 100 ml (A4222) Z6524 Airless insert for wheelchair tires (K0064) Z6525 CHS DME only Z6526 Customized wheelchair seating system, to include all necessary components (K0015) Z6527 Wheelchair power base component of power wheelchair Construction (K0013) Changes in reimbursement (rental/purchase) for certain codes - The following codes have changes relating to rental or purchase of the item. E0193 Powered air flotation bed (low air loss therapy) - may be purchased through capped rental only E0194 Air fluidized bed - may be purchased through capped rental only E0608 Apnea monitor - rental only, no purchase outright (exempt from capped rental) E0452 Intermittent assist with continuous positive airway pressure device (BiPAP S) - exempt from capped rental E0453 Therapeutic ventilator; suitable for 12 hours or less per day (BiPAP ST) - exempt from capped rental E0601 Continuous positive airway pressure (CPAP) device - exempt from capped rental K0193 CPAP device with humidifier- exempt from capped rental If you have any questions please contact the Provider Relations Unit at 1-800-251-1268 or 777-5501 in Cheyenne In order to process questions in a timely manner, please have all information including your provider number, recipient number, date of service, TCN, and remittance advice ready when you call. If you have more than three inquiries regarding claims, please complete a Provider Inquiry Form and mail it to us at the address below. Consultec, Inc. P. O. Box 667 Cheyenne, WY 82003-0667 13