Name of Manual - Blue Cross and Blue Shield of Minnesota

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Chapter 11 Coding Policies and Guidelines (Durable Medical Equipment) Table of Contents Durable Medical Equipment (DME) Definition.................................................................. 11-2 Enrollment Requirements when Providing Services to MHCP Subscribers .......................11-2 Prior Authorization Requirements ....................................................................................... 11-3 Ineligible Items ....................................................................................................................11-4 DME Rental Guidelines.......................................................................................................11-5 Medicare Advantage DME Rental Guidelines .................................................................... 11-5 Waivers and Upgraded/Deluxe DME ..................................................................................11-7 Waiver Claim Submission ................................................................................................... 11-7 Sample Waiver Form ........................................................................................................... 11-8 DME Coding........................................................................................................................ 11-8 Sales Tax..............................................................................................................................11-9 Handling/ Conveyance......................................................................................................... 11-9 Claims Filing Requirements ................................................................................................ 11-9 Hearing Aids ......................................................................................................................11-10 Oxygen and Oxygen Aiding Equipment (includes ventilators).........................................11-12 Portable Oxygen Billing ....................................................................................................11-12 Coding Modifiers............................................................................................................... 11-13 DME Repairs and Maintenance (Excluding Oxygen Equipment).....................................11-14 Replacement of Purchased Equipment .............................................................................. 11-14 Billing for Supplies............................................................................................................ 11-15 Rental Unit Submission .....................................................................................................11-16 Hospital DME Providers.................................................................................................... 11-16 DME/Supply Internet Purchases........................................................................................ 11-17 E0935 Rental Guides ......................................................................................................... 11-17 Pharmacies Submitting DME Claims ................................................................................11-17 DME and Specialty Pharmacy Billed through the BlueCard ® Program............................11-18 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 08/15/2012) 11-1
Coding Policies and Guidelines (Durable Medical Equipment) Durable Medical Equipment (DME) Definition Enrollment Requirements when Providing Services to MHCP Subscribers 11-2 Blue Cross and Blue Shield of Minnesota (Blue Cross) defines DME as equipment and related health care supplies and services that are: able to withstand repeated use; and used primarily for a medical purpose; and generally not useful in the absence of illness or injury; and determined to be reasonable and necessary; and prescribed by a physician; and represents the most cost-effective alternative. Effective January 1, 2012, Minnesota Statutes Section 256B.0625 requires that DME and Orthotic & Prosthetic (O&P) providers be enrolled as Medicare providers if the provider provides services to individuals enrolled in Minnesota Health Care Programs (MHCP). This includes subscribers enrolled in Blue Advantage (PMAP, MinnesotaCare and Minnesota Senior Care Plus) and SecureBlue SM (HMO SNP). Enrollment in Medicare requires that providers accept Medicare’s assignment of claims and payment for services. According to the Centers for Medicare & Medicaid Services (CMS), DME and O&P providers are enrolled as Medicare providers after their Medicare enrollment application has been completed and approved by Medicare. Minnesota Statutes Section 256B.0625, subd. 31 reads, in part, as follows: “Medical supplies and equipment… (b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies must enroll as a Medicare provider.” Blue Cross participating providers agree to comply with all applicable state and federal laws, rules, regulations, orders and requirements. Therefore, all DME and O&P participating providers who provide services/products to MHCP and Medicare subscribers must be enrolled with Medicare per Minnesota Statutes Section 256B.0625. In addition to the changes noted above, Blue Cross requires all DME and O&P providers to submit the ordering and referring provider information via loop 2420E in the electronic transaction. Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/15/2012)
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Blue Cross and Blue Shield of Minne
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Recent Chapter changes: Chapter 11
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Chapter 11 - Coding Policies and Gu
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Durable Medical Equipment Date Topi
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Medical Emergency Date Topic Change
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Rehabilitative Services Date Topic
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Table of Contents Chapter 1 At Your
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Introduction Provider Policy and Pr
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How to Contact Us At Your Service P
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At Your Service Claims Address Subm
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Care Management Numbers and Address
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Care Management Numbers and Address
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Company Phone Number Address Public
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At Your Service Provider Identifica
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ID Cards At Your Service Introducti
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Electronic Commerce Overview An imp
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Remote Access Services (continued)
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Provider Communications Provider Co
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Health Plan Members have the Follow
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Provider Agreements Participation a
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Provider Agreements Responsibilitie
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Provider Agreements Provider Number
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Provider Agreements Accounting for
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Provider Agreements Carrier Replace
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Table of Contents Chapter 3 Quality
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Quality Improvement Leadership Rati
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Quality Improvement Telephone Care:
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Quality Improvement Quality of Care
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Quality Improvement Written Policie
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Quality Improvement Written Policie
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Quality Improvement Patient Safety
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Quality Improvement Medical Record
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Quality Improvement Institute for C
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Quality Improvement Quality Improve
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Quality Improvement Physical Facili
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Quality Improvement Treatment Recor
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Integrated Health Management Progra
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Integrated Health Management Provid
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Integrated Health Management Utiliz
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Integrated Health Management Medica
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Integrated Health Management Overvi
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Integrated Health Management Pre-Ce
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Integrated Health Management Decisi
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Integrated Health Management Defini
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Integrated Health Management For Lo
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Integrated Health Management Appeal
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Integrated Health Management Case &
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Integrated Health Management Diseas
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Integrated Health Management Focuse
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Integrated Health Management Specia
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Integrated Health Management Overvi
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Integrated Health Management Sample
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Health Care Options Prepaid Medical
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Health Care Options Member ID Cards
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Health Care Options Blue Cross and
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Health Care Options Double Gold Dou
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Health Care Options Medicare Basic
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Health Care Options Platinum Blue S
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Health Care Options MedicareBlue PP
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Health Care Options Inquiries and C
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Health Care Options Additional info
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Health Care Options Minnesota Senio
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Health Care Options MinnesotaCare P
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Health Care Options BlueLinkTPA Blu
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Health Care Options Delta Dental Hi
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Health Care Options Prime Therapeut
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Health Care Options Workers' Compen
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Health Care Options HICF 1500 Form
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Health Care Options Networks Blue C
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Blue Plus Member Information Introd
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Blue Plus Member Rights and Respons
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Blue Plus Member Rights and Respons
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Blue Plus Member Benefits Members
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Blue Plus Quality of Care Complaint
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Blue Plus Referral Points Remember
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Blue Plus Referral Not Required We
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Blue Plus Standing Referral Minneso
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Blue Plus Clarifications of Terms (
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Blue Plus [Date] [Name of patient]
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Blue Plus Special Member Benefits O
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Blue Plus OB/GYN Open Access Diagno
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Blue Plus OB/GYN Open Access Diagno
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BlueCard® Claim Status Inquiry ...
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BlueCard® Identifying BlueCard ®
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BlueCard® Identifying BlueCard ®
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BlueCard® BlueCard Service Claims
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BlueCard® Prior Authorization and
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BlueCard® Electronic Data Intercha
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BlueCard® Claims Processed by the
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BlueCard® Overview (continued) 3.
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BlueCard® Claim Payment Guidelines
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BlueCard® Calls from Members and O
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BlueCard® Guidelines (continued) W
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BlueCard® Types of Medicare Advant
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BlueCard® Medicare Advantage Claim
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BlueCard® Reimbursement for Medica
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Claims Filing HCPCS/ Accommodation
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Claims Filing Administrative Simpli
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Claims Filing Claims with Attachmen
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Claims Filing Claims with Coordinat
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Claims Filing Claims with Coordinat
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Claims Filing 1500 HICF Form Profes
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Claims Filing Ordering Forms and Ma
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Claims Filing Site of Service (cont
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Claims Filing Institution (837I) /F
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Claims Filing Treatment Room Blue C
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Claims Filing Single facility claim
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Claims Filing Present on Admission
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Claims Filing Medicare Crossover Bl
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Claims Filing Cancel/Void and Repla
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Claims Filing Verifying Patient Eli
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Claims Filing Basic Character Set V
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Claims Filing Rural Health Clinics
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Claims Filing Coordination of Benef
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Claims Filing TEFRA The 1982 Tax Eq
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Claims Filing Employment As defined
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Claims Filing Surgical Technicians
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Reimbursement / Reconciliation Reim
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Reimbursement / Reconciliation Comp
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Reimbursement / Reconciliation Remi
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Acco
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Reimbursement / Reconciliation Fiel
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Appeals Provider Appeals Introducti
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Appeals Submitting Requests for Pos
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Appeals Coding Appeals (continued)
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Appeals Supporting Documentation (c
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Coding Policies and Guidelines (Cod
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Coding Policies and Guidelines (Cop
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Coding Policies and Guidelines (Mod
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Chapter 11 Coding Policies and Guid
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Part-time (Medically Directed) Anes
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Electroconvulsive Treatments Blue C
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Moderate (Conscious) Sedation Monit
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Coding Policies and Guidelines (Beh
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Coding Restrictions Code Restrictio
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CTSS Skills Training and Developmen
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Intensive Residential Treatment Ser
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IRTS Member Eligibility IRTS Access
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Adult Non-Residential Crisis Servic
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MH-TCM Services to Minnesota Health
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Dialectical Behavioral Therapy/DBT
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Autism Spectrum Disorder/EIBI (cont
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Autism Spectrum Disorder/EIBI (cont
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Psychiatric Consultation to Primary
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Psychiatry and Chemical Dependency
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Medication Management M0064 and 908
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Nutritional Counseling/Medical Nutr
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Practitioner Key MD = Psychiatrist
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Clinical Supervision Under Minnesot
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DIAMOND Initiative (continued) Reim
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Missed Appointments (continued) Cou
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Guidelines for Court Ordered Evalua
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Guidelines for Court Ordered Evalua
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Behavioral Health Quality Improveme
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Pre-certification and Concurrent Re
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Coding Policies and Guidelines (Mat
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Drugs Coding Policies and Guideline
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Drug Programs Coding Policies and G
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Coding Policies and Guidelines (Pub
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Physical Therapy Evaluation Codes C
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Hot and Cold Pack Exclusion TMJ Ort
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Massage and Manual Therapy Exclusio
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MHCP PT, OT, ST Authorization Proce
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Bilateral Services (continued) Codi
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Coding Policies and Guidelines (Sur
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Acne Treatment/ Skin Rejuvenation a
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Liposuction Edit Change Coding Poli
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Assistant Surgeons (continued) Assi
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