Health and Recovery Services Administration, Department of Social and Health Services
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Other Durable Medical Equipment

(DME)


Frequently Asked Questions
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LATEST UPDATES  

Answers to the most commonly asked questions related to rates for Other DME

4/1/2008 - The April 1, 2008 Rate Updates are available for download.

12/11/07 - The January 1, 2008 Rate Updates will be available for download this week.

3/21/07 - The April 1, 2007 fee schedule updates will be available for download next week.  In April we update the Wheelchair and Accessories, and Other DME fee schedules.

1/4/07 -
CMS plans to kick off competitive bidding in 10 cities in 2007. A meeting with approved accreditors at CMS was held and a list of 19 cities, 10 of which will be the first round of contracting, was handed out and although was to be secret, was leaked out.  Seattle is in the list of 19 cities and could be in the first round of contracting.

The 19 cities are: Miami, Charlotte, N.C.; Dallas; Riverside, Calif.; Pittsburg; Kansas City, Mo., and Kan.; Cincinnati; San Juan; Cleveland; San Francisco; Atlanta; Houston; Detroit; Seattle; Baltimore; Philadelphia; Phoenix; Boston; and Tampa.

The list includes two cities that were left out of a previously released list of 25 potential cities: Seattle and Phoenix.


1/1/07 - Codes will be updated

10/19/06 - The CareFair Power Point presentation from 10/18/06.  Download it by right clicking here.


7/1/06 - There was a rate increase

03/08/06-
CMS has made changes to some billing codes and rates for this program.  HRSA has updated our fee schedule to match the fees of CMS.  Revisions will be effective for dates of service on and after April 1, 2006.

12/22/05- CMS has made changes to the billing codes for this program.  HRSA is updating our fee schedule to match the codes of CMS.  Revisions will be effective for dates of service on and after January 1, 2006.  Changes may include additions, deletions and changes of descriptions.  Depending on the changes there may also be changes to some rates and policy.

4/1/05 - The new August 1 fee schedule became effective

2/10/05 - The new fee schedule is expected to be posted by March 18.

1/12/05 - This fee schedule will be updated next on April 1, 2005.

1/1/05 - MAA published the new fee schedule with updated HCPCS according to those that CMS deleted and added.  MAA received the updates on 10/28/04 and immediately started the update process.  CMS did not make the rates available until December 29.  CMS no longer allows any grace period to use the deleted codes.

10/1/04
The new Other DME fee schedule is final and available under the billing instruction link below left.

9/13/04
The Other DME Fee Schedule is ready for review and comment.  The revised rates will be implemented on October 1.  Comments may be sent to Alan McMullen at
mcmular@dshs.wa.gov.

The DRAFT copy of the fee schedule may be downloaded by - no longer available.

9/13/04
MAA is reviewing the three items listed under code A4535 with the intention of setting a rate with an EPA for each type of item.

8/10/04
The initial published rate of .87 cents for A4524 Adult Diaper Extra Large is not correct and is .94 cents each.
 

Code A4535, Liner/Shield/Undergarment:  We have had some feedback that the reimbursement of .44 cents is not enough for the undergarments.  We reviewed those concerns and have determined that we do not have enough data to make a change at this time.  The feedback we received was not accompanied with any cost information to use in our decision making.

6/24/04
MAA is beginning to revise the reimbursement rates for this area of the DME program.  We welcome your comments and suggestions.  You may send them to: 
Alan McMullen.

New rates will be implemented on October 1, 2004.


4/1/04
The HCPCS codes were revised to reflect the deleted, replaced and new codes as defined by CMS.


Rates Reimbursement
Contact

Melissa Usitalo: 
usitaml@dshs.wa.gov

Melissa is the contact for the actual reimbursement rates.  

For questions regarding the actual amounts paid, billing questions, or policy questions
click here

 
Related WAC (Washington Administrative Code)
Click here

The WAC provides information on policy, parameters of the program as well as the methodology to determine reimbursement rates.

Billing Instructions
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The BI includes policy related to the program and the process for billing services.

 
Fee Schedule
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The fee schedule is a spreadsheet of billing codes and maximum reimbursement amounts.

 


For comments or questions regarding Other DME, email contact us


Page modified: November 2009       

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