Attention Hospitals Billing Durable Medical Equipment (DME) Supplies

November 15, 2013

It has come to our attention that some hospitals are billing DME HCPCS codes and may have been paid. Please refer to the hospital policy in the MaineCare Benefits Manual, Chapter II Section 45 (45.04-4) http://www.maine.gov/sos/cec/rules/10/ch101.htm.

45.04-4 Supplies, Appliances and Equipment

Supplies, appliances and equipment are covered if they are surgically implanted or are an integral part of a hospital procedure and it would be medically contraindicated to limit the patient's use of the item to his or her hospital stay (e.g.: cardiac valves, pacemakers, tracheotomy tubes, halovests, titanium rods, etc.).

A temporary or disposable item that is medically necessary to facilitate the patient's discharge from the hospital, and is required until the patient can obtain a continuing supply, is covered as an inpatient service for up to a ten (10) day supply.

Except as noted above, supplies, appliances, including prosthetic devices, and equipment furnished to an inpatient or outpatient for use outside of the hospital must have prior authorization in accordance with and meet criteria in Chapter II, Section 60, Supplies and Durable Medical Equipment, of this Manual, and reimbursement must be made to a supplier of durable medical equipment. MaineCare will not reimburse a hospital or supplier of durable medical equipment for the rental or purchase of a therapy bed (specialty air beds built into a hospital bed frame).

Hospitals that choose to become a DME dealer can enroll under Chapter II Section 60.01-12 of the MaineCare Benefits Manual to be reimbursed for these services.

The Department encourages hospital providers to conduct a self-audit to determine if overpayments have occurred.