Medical Supplies And Durable Medical Equipment
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingMedical Supplies and Durable Medical EquipmentUpdated January 2021Section 2Medical Supplies and Durable Medical EquipmentTable of Contents1General Information. 31-1Medical Supplies and Durable Medical Equipment (DME) Services . 32Health Plans . 33Provider Participation and Requirements . 34Record Keeping . 35Provider Sanctions . 46Member Eligibility . 47Member Responsibilities . 48Programs and Coverage . 48-1Definitions . 48-2Requirements for Obtaining Medical Supplies or DME . 58-3Face-to-Face Requirement . 68-4Quantity Limits . 68-5Long Term Care Facilities - Medical Supply and DME Coverage . 68-5.1Nursing Facility Reimbursement. 78-5.2Equipment and Supplies within the Per Diem Rate. 78-5.3Equipment and Supplies Reportable as Ancillary Services . 78-6Purchases and Rentals . 88-6.1Purchased Equipment . 88-6.2Capped Rental . 88-6.3Continuous Rental . 88-7Incontinence Products . 88-8Urinary Catheters . 98-9Nutritional Services . 98-9.1Donor Human Milk . 98-9.2Total Nutrition by Enteral Tube . 108-9.3Oral or Tube Supplemental Nutrition and Total Oral Nutrition: . 108-9.4Inborn Errors of Metabolism. 118-9.5Nutritional Products and Residents of Long-Term Care Facilities. 11Page 1 of 26Section 2
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingMedical Supplies and Durable Medical EquipmentUpdated January 20218-9.6Parenteral Therapy . 118-9.7Coverage Limitations for Nutritional Products . 118-10Prosthetic and Orthotic Devices . 118-11Speech Generating Devices (SGD) and Augmentative Alternative Communication Devices (AAC) . 118-12Oxygen and Related Respiratory Equipment . 128-12.1Oxygen Concentrator and Backup Oxygen Supply . 128-12.2Stationary Gaseous Oxygen System . 128-12.3Portable Gaseous Oxygen . 128-12.4Liquid Oxygen Systems . 128-12.5Ventilators . 138-13Monitoring Equipment . 138-13.1Apnea Monitor . 138-13.2Blood Glucose Monitors . 138-14Wheelchairs . 138-14.1General Information . 138-14.2Wheelchair Evaluation Forms . 148-14.3Manual Wheelchair . 158-14.4Power Wheelchairs . 158-14.5Accessories, Attachments, Components and Options . 158-14.6 Members Residing in Long-Term Care Facilities . 188-15Equipment Service Requirements . 188-15.1General Equipment Service Requirements Information . 188-15.2Maintenance . 198-15.3Repairs . 198-15.4Replacements . 228-15.5Warranties . 239Non-Covered Services . 2310Prior Authorization . 2310-1Medicare and Prior Authorization . 2310-2Retroactive Authorization . 2310-3Transition of Care . 2311Billing . 2311-1Returned Medical Supplies or DME . 2311-2Billing for Liquid Oxygen . 2412Coding . 24Page 2 of 26Section 2
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingMedical Supplies and Durable Medical EquipmentUpdated January 202112-1Repairs . 2412-2Wheelchair Evaluations . 2412-3Healthcare Common Procedure Coding System (HCPCS) Miscellaneous Codes . 2412-4Modifiers . 24Resource Table . 251General InformationAll underlined words contained in this document should serve as hyperlinks to the appropriate internetresource. Email dmhfmedicalpolicy@utah.gov if any of the links do not function properly noting thespecific link that is not working and the page number where the link is found.For general information regarding Utah Medicaid, refer to Utah Medicaid Provider Manual, Section I:General Information (Section I: General Information).1-1Medical Supplies and Durable Medical Equipment (DME) ServicesThe Utah Medicaid Provider Manual, Section 2, Medical Supplies and Durable Medical Equipment isdesigned to be used in conjunction with the Section I: General Information as well as other sections andattachments. Refer to Utah Medicaid website at https://medicaid.utah.gov for additional resources.Not all medical supplies and DME are mentioned within this manual. However, the Coverage andReimbursement Code Lookup contains information related to the coverage status and limitations forspecific items, listed by Healthcare Common Procedure Code (HCPCS).Information in this manual represents services available when medically necessary. For informationregarding medical necessity refer to Section I: General Information Chapter 8-1 Medical Necessity.For information specific to EPSDT eligible members refer to the EPSDT Services Manual.2Health PlansInformation specific to ACOs can be found in Section I: General Information, Chapter 2, Health Plans.Refer to Section I: General Information Chapter 1-7, Fee-for-Service and Managed Care for informationregarding Accountable Care Organizations (ACOs) and how to verify if a Medicaid member is enrolledin an ACO.3Provider Participation and RequirementsTo enroll as a Medicaid provider for medical supplies and DME refer to Section I: General InformationChapter 3, Provider Participation and Requirements.4Record KeepingPage 3 of 26Section 2
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingMedical Supplies and Durable Medical EquipmentUpdated January 2021Refer to Section I: General Information, Chapter 4, Record Keeping.5Provider SanctionsRefer to Section I: General Information, Chapter 5, Provider Sanctions.6Member EligibilityIt is the responsibility of the provider to verify the member's eligibility each time before service isrendered. For additional information regarding member eligibility refer to Section I: GeneralInformation Chapter 6, Member Eligibility.7Member ResponsibilitiesFor information on member responsibilities including establishing eligibility and co-paymentrequirements refer to Section I: General Information, Chapter 7, Member Responsibilities.8Programs and Coverage8-1DefinitionsThe following definitions are specific to the content of this manual.Definitions of terms used in multiple Medicaid programs are in Section I: General Information, Chapter1-9, Definitions and Utah Administrative Code R414-1.Carve-Out Services: Services not included in the Medicaid contract with an ACO are carve-outservices and paid through fee-for-service. Apnea monitors are the only DME carve-out item from theACO plans. The contractor for apnea monitors is Apria HealthcareCustomized Manual Wheelchair: A wheelchair that has been measured, fitted, or adapted inconsideration of the member’s body size, disability, period of need, or intended use, and has beenassembled by a supplier or ordered from a manufacturer who makes available customized features,modifications, or components for wheelchairs that are intended for individual member’s use inaccordance with instructions from the member’s physicianDurable Medical Equipment or Equipment: Items that are primarily and customarily used to serve amedical purpose, are not generally useful to an individual in the absence of a disability, illness or injury,can withstand repeated use, and can be reusable or removableEnteral Nutrition (EN): EN is the provision of nutritional requirements through a tube into thegastrointestinal (GI) tract and may be administered by syringe, gravity, or pumpMaintenance: Servicing of equipment which, based on the manufacturer’s recommendations, needs beperformed by a providerManual wheelchair: A wheelchair that can be self-propelled or pushed by another individual and is nota power wheelchairPage 4 of 26Section 2
Utah Medicaid Provider ManualDivision of Medicaid and Health FinancingMedical Supplies and Durable Medical EquipmentUpdated January 2021Medical Supplies or Supplies: Items that are consumable or disposable, or cannot withstand repeateduse by more than one individual that is required to address an individual medical disability, illness orinjuryNational Drug Code (NDC): Unique product identifier used in the United States for drugs intended forhuman useOptimally-Configured Manual Wheelchair: A manual wheelchair with an appropriate wheelbase,device weight, seating options, and other appropriate non-powered accessoriesOrthotic Device: An orthopedic appliance or apparatus used to support, align, prevent, or correctdeformities or to improve the function of movable parts of the bodyPhysician: Defined in section 1861(r)(1) and 1861(aa)(5) of the Social Security Act and acting withintheir scope of practicePower Wheelchair: A wheelchair that is propelled by means of an electrical motor rather than manualpowerProsthetic Device: Replacement, corrective or supportive devices prescribed by a physician toartificially replace a missing portion of the body, prevent or correct physical deformity or malfunctions(including promotion of adaptive functioning), or support a weak or deformed portion of the bodyRepair: To fix or mend and to put the equipment back in good condition after damage or wearReplacement: To change an existing piece of equipment with an identical or nearly identical itemTotal Parenteral Nutrition (TPN): Nutritional support given by means, such as intravenously (IV),other than through the GI tractWarranty: A guarantee to the purchaser or owner of equipment promising to repair or replace, ifnecessary, within a specified period of time8-2Requirements for Obtaining Medical Supplies or DMEOrders for equipment or supplies require: documentation supporting medical necessity maintained in the member’s medical recordso submission of documentation for PA a physician’s order including the following information: member’s name date of the order the start date, if the start date is different from the date of the order diagnosis a detailed description of equipment or supplies duration of use for items on a periodic basis the written order must include dosage andduration frequency of usePage 5 of 26Section 2
Utah Medicaid Provider ManualDivision of Medicaid and Health Financing Medical Supplies and Durable Medical EquipmentUpdated January 2021number of refillsrefills expire 12 months from the date of initial signaturequantity to be dispensedroute of administrationa physician’s signature in accordance with Section I: GeneralInformation Chapter 4-6, Signature RequirementsMedical supplies that are filled monthly, may be refilled between day 25 and 30 to assure the memberhas the needed product in time for the next month usage.8-3Face-to-Face RequirementIn accordance with 42 CFR 440.70 providers are required to comply with the face-to-face requirementsrelated to equipment and supplies. Providers must be aware of equipment and supplies required to havea face-to-face evaluation as mandated by the Center for Medicare and Medicaid Services (CMS). Seethe CMS Face-to-Face Encounter Requirement for Certain Durable Medical Equipment for details.For the initiation of equipment and supplies requiring a face-to-face evaluation, the evaluation must berelated to the primary reason the member requires the item and must occur no more than six monthsprior to the start of services.Documentation must support that the face-to-face encounter is related to the primary reason the memberrequires medically necessary equipment or supplies and occurred within the required timeframes priorto the start of services.In addition, documentation must indicate: the evaluating physician the date of the face-to-face if the evaluation was conducted via telehealthCoverage of equipment or supplies will be denied unless the physician documents a face-to-faceencounter with the member consistent with the requirements outlined in this manual, UtahAdministrative Code R414-1-30, and 42 CFR 440.70.All other criteria, in addition to the face-to-face requirement, for equipment and supplies must be met toqualify for coverage.8-4Quantity LimitsInformation regarding quantity limits can be found in Section I: General Information, Chapter 9-3.5,Quantity Limits. Specific HCPCS code quantity limits for equipment and supplies can be found usingthe Coverage and Reimbursement Code Lookup.8-5Long Term Care Facilities - Medical Supply and DME CoverageFor details on covered equipment and supplies for members residing in a Long-Term Care Facility, referto the Utah State Plan, Attachment 4.19-D 430 Non-Routine Services.Page 6 of 26Section 2
Utah Medicaid Provider ManualDivision of Medicaid and Health Financing8-5.1Medical Supplies and Durable Medical EquipmentUpdated January 2021Nursing Facility ReimbursementFor details refer to Medicaid’s Long-Term Care Resources.8-5.2Equipment and Supplies within the Per Diem RateFor the purposes of this manual equipment, supplies, and services, for members residing in long-termcare facilities, that are covered in the per diem rate include, but are not limited to, the following: Routine personal hygiene items and services as required to meet the needs of the member:basinsbedpansbrushcombcotton ballscotton swabsdental flossdenture adhesive 8-5.3CPAP/Bi-PAP suppliesgauzehospital gownsincontinence suppliesirrigation suppliesIV equipmentostomy suppliesoxygen masksoxygen tubingroutine dressingssuppositoriessyringestapetongue depressorsItems used by individual patients which are reusable and expected to be available such as:bed railscanescrutchesice bags soapstissuest
1-1 Medical Supplies and Durable Medical Equipment (DME) Services The Utah Medicaid Provider Manual, Section 2, Medical Supplies and Durable Medical Equipment is designed to be used in conjunction with the Section I: General Information as well as other sections and attachments.
Durable And Home Medical Equipment And SuppliesDurable And Home Medical Equipment And SuppliesDurable And Home Medical Equipment And Supplies Durable and Home Medical Equipment and Supplies . Library Reference Number: PROMOD00024 3 Published: Oct. 27, 2022 Policies and procedures as of June 1, 2022 Version: 5.0
Part 2 – Medical Supplies: Billing Examples Page updated: August 2020 Tracheostomy Supplies: Contracted Figure 1. Tracheostomy supplies, contracted. This is a sample only. Please adapt to your billing situation. In this example, a Durable Medical Equipment (DME) company is billing for contracted tracheostomy supplies.
ControlLogix power supplies are used with the 1756 chassis to provide 1.2V, 3.3V, 5V, and 24V DC power directly to the chassis backplane. Standard, ControlLogix-XT , and redundant power supplies are available. Topic Page Standard AC Power Supplies 2 Standard DC Power Supplies 4 1756 ControlLogix-XT Power Supplies 7 Redundant Power Supplies 9
Maverick provides DME and supplies from its storefront location and offers direct delivery to Medicaid beneficiaries. Incontinence supplies outside the county are drop-shipped. 3. through a third-party supplier for DME and supplies. 4. Maverick received Texas Medicaid reimbursements of 1,982,968 for DME and supplies
DAN RIVER HIGH SCHOOL SUPPLY LIST BY TEACHER 2018-2019 Teacher Name Course and Supplies Course and Supplies Course and Supplies Course and Supplies Course and Supplies Course and Supplies Aherron, Melissa 3 Anatomy/Physiology 3 -ring binder, loose leaf paper, pencils, blue/black ink pens, colored pens; colored pencils, highlighter, index cards
Le Ministère a publié, au printemps 2021 sur sa page Web « Développement durable », le Plan d'accompagnement-conseil du réseau scolaire en matière de développement durable 2021-2022, le principal outil de planification de ses interventions en matière de développement durable dans le réseau scolaire.
Medical Commodities: A collective term to include pharmaceuticals, consumable medical supplies, and durable medical equipment. Medical Equipment (Durable): This term refers to commodities designed for humans or animals that may generally be reused after proper cleaning and disinfection. Medical equipment includes but is not limited to
4.3 STAGES OF SOCIAL WORK GROUP FORMATION There are a number of stages or phases in formation of a social work group. Ken Heap (1985) discussed these as group formation and planning; the first meetings; the working phase; use of activities and action; and the termination of the Group. According to Douglas (1979) there are five stages viz., conceptualisation, creation, operation, termination .
