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HCFA Common Procedure Coding System (HCPCS) codes provide a uniform method of accurately describing services rendered, should be used for reporting DME services. The “A”, “E”, “K”, and “L” HCPCS codes are a part of the Preferred DME Network.
Procedure code modifiers should be used along with procedure codes unless the claim is for rental equipment. A claim for purchased equipment will be processed as rental equipment when submitted without the appropriate modifier.
NU: New durable medical equipment
Existing Rental Equipment
Blue Cross and Blue Shield of Alabama will consider medical equipment to be purchased after ten months rental. This guide does not apply to life sustaining equipment. Examples of life sustain equipment include oxygen equipment such as concentrators, liquid and gaseous oxygen supply systems and home dialysis equipment and ventilators.
Note: The ten months rental period includes reasonably medically necessary supplies on most DME items and should not be filed separately. Purchased DME includes reasonably medically necessary supplies on most items for the first ten months after the initial purchase and should not be filed separately.
Repairs and Replacement Supplies
Repair or service must require the skill of a technician. Labor components are identified in 15-minute increments as number of services on the claim. Any necessary replacement part(s) used in the repairs must be filed with a copy of the purchase invoice. Each part should be listed with a detailed description and price for allowance determination.
Certificate of Medical Necessity
Effective October 1, 2003, Blue Cross and Blue Shield of Alabama no longer require a Certificate of Medical Necessity (CMN) form be filed with a durable medical equipment (DME) claim. Required documentation is requested on an as needed basis.
It is necessary that providers maintain the following documentation:
Preferred DME Suppliers are responsible for notifying the patient of equipment that does not meet medical criteria for coverage in the treatment of his/her condition. The patient should sign the statement prior to the equipment being supplied. Maintain a copy of the signed non-covered statement as a part of the patient’s medical record. An example of a non-covered statement is available in the Provider Manual.
If the place of treatment is the retail store (place of treatment 17), the claim should be filed to the plan in the state where the store is located.
If the place of treatment is the home (place of treatment 12), the claim should be filed to the plan in the state where the member lives.
Please note, the address listed in Block 32 of the CMS 1500 or the corresponding electronic claim field should be an Alabama address when billing services to Alabama.