Chapter 14 Durable Medical Equipment (DME)

Durable Medical Equipment (DME) 14for pregnant women, recipients less than 18 years of age, emergencies, surgical fees,and family planning.The Medicaid DME Program requires copayment at the following rates:ItemDurable Medical Equipment, includingcrossoversSupplies and Appliances, includingcrossoversIron Infusion Pump RepairCopay Amount$3.00 for each item$3.00 for items costing $50.01 or more$2.00 for items costing $25.01-$50.00$1.00 for items costing $10.01-$25.00$.50 for items costing $10.00 or less$3.00 for each Prior Authorization (PA)NumberThe provider may not deny services to any eligible Medicaid recipient because of therecipient’s inability to pay the cost-sharing amount imposed.14.6 Completing the Claim FormTo enhance the effectiveness and efficiency of Medicaid processing, providersshould bill Medicaid claims electronically.DME providers who bill Medicaid claims electronically receive thefollowing benefits:• Quicker claim processing turnaround• Immediate claim correction• Enhanced online adjustment functions‣ Electronicclaimssubmission cansave you timeand money.The systemalerts you tocommon errorsand allows youto correct andresubmitclaims online.• Improved access to eligibility informationRefer to Appendix B, Electronic Media Claims Guidelines, for more information aboutelectronic filing.NOTE:When filing a claim on paper, a CMS-1500 claim form is required. Medicarerelatedclaims must be filed on the Medical Medicaid/Medicare-related ClaimForm.Refer to Chapter 5, Filing Claims, for general claims filing information and instructions.14.6.1 Time Limit for Filing ClaimsMedicaid requires all claims for DME to be filed within one year of the date of service.Refer to Section 5.1.5, Filing Limits, for more information regarding timely filing limitsand exceptions.14.6.2 Diagnosis CodesDME providers may bill diagnosis code V729 on hard copy and electronicallysubmitted claims.April 2005 14-33