Section 60 Medical Supplies and Durable Medical Equipment (DME), Billing Guidance and Corrections
Reimbursement Methodology Changes
- Changes not reflected on the Usual Customary and Reasonable (UCR) Fee Schedule
On January 1, 2023, the Department implemented reimbursement methodology and rental period changes for DME and medical supplies to align with Medicare. These changes included adding rural and non-rural rates and secondary modifiers, which the MaineCare UCR Report is not able to reflect. Given this, the Department will make changes to remove all codes covered under Section 60 from the MaineCare UCR Report.
Instead of referencing the UCR, for an accurate fee schedule of codes, modifiers, and rates, Section 60 providers should now refer to the Section 60 fee schedule. The Department plans to add an Excel version of the Section 60 fee schedule so providers can more easily upload the correct rates into their own internal fee schedules for billing purposes. The Department will send a notice once the files are available on the website.
- Purchase and Rental Options
On January 1, 2023, the Department also added and removed purchase and rental options for items in accordance with Medicare. Since then, we have made additional systems changes to allow claims to process properly in accordance with Medicare guidelines. Prior Authorizations (PA) and claims will now process appropriately based on whether an item has a purchase and/or rental option. Section 60 providers should refer to this Section 60 fee schedule to determine whether an item has a rental and/or purchase option. No provider action is needed.
Claims Paying Incorrectly
- The Department corrected a system error related to sales tax code S9999. The Department also corrected a system error that was causing provider claims for two or more units of a code to pay the amount for one unit.
The Department will reprocess relevant claims following this notice. No provider action is needed.
- No Purchase Options for Codes E2312 and E2313
The Department inadvertently removed the purchase options for codes E2312 and E2313 and has since reestablished the purchase options for these codes retroactively to January 1, 2023, to align with Medicare. The Department has already reprocessed PA requests for purchasing these items. No provider action is needed.
Manually Priced Codes No Longer on the Fee Schedule
MaineCare removed codes that are manually priced from the Section 60 fee schedule because they do not have rates. Previously, the fee schedule indicated the rate cap for these codes or that they paid “By Invoice.” These codes are still covered but are no longer included in the fee schedule. Providers can check the Rate Setting Website to confirm covered services.
If you have any questions, please contact your Provider Relations Specialist.