Section 418.101003b. Reimbursement for biologicals, durable medical equipment, and supplies.

b. (1) The carrier shall reimburse durable medical equipment (DME), supplies, and biologicals at Medicare plus 5%. The health care services division shall provide the maximum allowable payments for DME, supplies, and biologicals separate from these rules on the agency website, www.michigan.gov/wca. Biologicals that have NDC numbers shall be billed and reimbursed under R 418.10912.

(2)   Rented DME shall be identified on the provider's bill by RR. Modifier NU will identify the item as purchased, new.

(3)   If a DME, supply, or biological exceeding $35.00 is not listed in the fee schedule, or if the service is billed with a not otherwise specified code, then reimbursement shall be manufacturers’ invoice cost plus a percent mark-up as follows:

(a)   Invoice cost of $35.01 to $100.00 shall receive cost plus 50%.

(b)   Invoice cost of $100.01 to $250.00 shall receive cost plus 30%.

(c)   Invoice cost of $250.01 to $700.00 shall receive cost plus 25%.

(d)  Invoice cost of $700.01 or higher shall receive cost plus 20%.

History: 2006 AACS; 2014 AACS.