Section 418.10913. Billing for durable medical equipment and supplies.

(1) Durable medical equipment (DME) and supplies shall be billed using the appropriate descriptor from HCPCS, Medicare's National Level II codes, as referenced in R 418.10107, for the service. If the equipment or supply is billed using an unlisted or not otherwise specified code and the charge exceeds $35.00, then an invoice shall be included with the bill.

(2)   Initial claims for rental or purchased DME shall be filed with a prescription for medical necessity, including the expected  time   span the equipment will be required.

(3)    Durable medical equipment may be billed as a rental or a purchase.If possible, the provider and carrier shall agree before dispensing the item as to whether it should be a rental or a purchased item. With the exception of oxygen equipment, rented DME is considered purchased equipment once the monthly rental allowance exceeds the purchase price or payment   of    12 months rental, whichever comes first.

(a)   If the worker's medical  condition   changes  or  does  not   improve as expected, then the rental may be discontinued in favor of purchase.

(b)   If death occurs, rental fees for equipment will terminate at the end of the month and additional rental payment shall not be made.

(c)   The return of rented equipment is the dual responsibility of the worker and the DME supplier. The carrier is not responsible and  shall not  be required to reimburse for additional rental periods solely because of a delay in equipment returns.

(d)   Oxygen equipment shall be considered a rental as long as the equipment is medically necessary.  The  equipment   rental  allowance    includes reimbursement for the oxygen contents.

(4)   A bill for an expendable medical supply shall include the brand name and the quantity dispensed.

(5)   A bill for a miscellaneous supply, for example; a wig, shoes,  or shoe modification, shall be submitted on an invoice if the supplier is  not listed as a health care professional.

History: 2000 AACS; 2006 AACS; 2008 AACS.