August 4, 2020

Alabama Media Portal 2.0 – Press Releases



PDF Version

TO:    DME
Providers, Prosthetics & Orthotics (P&O) Providers, Pharmacies,
Physicians, Physician Assistants, Nurse Practitioners, and Nursing Homes




 


The
Alabama Medicaid Agency’s Durable Medical Equipment Program will make changes
to:


·     
Reimbursement for CPAP (E0601)


·     
Humidifier Reimbursement (E0561, E0562)


·     
Mask
Reimbursement (A7030, A7032, A7035)


 


CPAP/Humidifier/Mask
Reimbursement


DME
Provider(s) that submit prior authorizations (PAs) for dates of service on or
after March 6, 2020 for CPAP devices:


·      Will be reimbursed for
CPAP, humidifier devices, and masks separately when billed on the same date of
service.


·      Will be reimbursed for
the humidifier as a rent to capped purchase when billed with a CPAP.


·      Will be reimbursed a
separate purchase price for masks when billed on the same date of              service.
Annual limitations apply.


·      Will be reimbursed the
published Medicare rate that is effective March 6, 2020.


Providers
may resubmit claims with prior authorizations approved for dates of service
March 6, 2020 and after.
Providers should bill 3 months rental with an LL
modifier. The final purchase payment should be billed without a modifier which
will then be considered a capped purchase.


Billable Modifiers to be used for CPAP
and Humidifier:


PAs
approved for dates of service March 6, 2020 or after


  LL modifier should be included for the
initial three-month rental period.


  NO modifier for the final month
(totaling 4 months capped).


RA
will be used for replacement of machine only, within 8-year period. Replacement
must be prior approved by Agency as directed by policy.


 


Reminder: CPAP therapy is covered through the
EPSDT Program for children up to the age of 21.
Requests for Medicaid’s
authorization of a replacement CPAP device will be accepted for review every
eight years. A request for replacement of the device submitted within less than
eight years which is due to a natural disaster, or an occurrence beyond the
recipient’s control, and not the result of misuse, neglect or malicious acts by
the user may be considered for approval and payment. The provider must obtain a
prior authorization, submit the claim electronically to DXC for processing with
the appropriate procedure code and Modifier
CR,
and keep all documentation in the recipient file. 


 


Policy questions concerning this provider notice should be
directed to the DME Program at (334) 242-5050. Questions regarding PA
procedures should be directed to Comagine Health at 1-800-949-7536.




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