Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Transmittal Letter OXY-29 May 2010 TO: Oxygen and Respiratory Therapy Equipment Providers Participating in MassHealth FROM: Terence G. Dougherty, Medicaid Director RE: Oxygen and Respiratory Therapy Equipment Manual (2010 HCPCS Updates) This letter transmits revisions to the service codes described in Subchapter 6 of the Oxygen and Respiratory Therapy Equipment Manual to comply with federal coding mandates, to incorporate coding and rate changes previously described in informational bulletins issued by the Division of Health Care Finance and Policy (DHCFP), and to remind providers of certain existing oxygen and respiratory equipment (OXY) policies and requirements. Providers may consult the Centers for Medicare & Medicaid Services (CMS) Web site at www.cms.gov for a full description of the service codes. Prior-authorization (PA) requirements, service limits, and place-of-service codes now appear in an updated version of the interactive MassHealth DME and Oxygen Payment and Coverage Guidelines Tool that has been posted on the MassHealth Web site. New OXY Service Code Additions and Deletions Effective for Dates of Service Beginning January 1, 2010 The additions and deletions to the MassHealth Service Codes and Descriptions included in this section are effective for dates of service on or after January 1, 2010. Claims for dates of service on or after January 1, 2010, submitted with deleted codes identified in this section will be denied. Claims denied for deleted codes should be resubmitted with the appropriate new codes. The following new codes have been added to Subchapter 6 of the Oxygen and Respiratory Therapy Equipment Manual and the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool. A7027 A7028 A7029 A7523 E0487 K0730 K0738 The following codes have been deleted from Subchapter 6 of the Oxygen and Respiratory Therapy Equipment Manual and the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool. A4610 E1340 S8100 S8101 S8180 S8181 S8190 MassHealth Transmittal Letter OXY-29 May 2010 Page 2 Modifier Change Effective for Dates of Service Beginning May 1, 2010 MassHealth is replacing modifier RP with RB. Effective for dates of service beginning May 1, 2010, providers must use modifier RB when submitting claims for repairs. MassHealth will not accept claims with modifier RP beginning with dates of service May 1, 2010. Providers who have billed Medicare for dates of service on or after March 1, 2009, using the modifier RB and who have received denials by MassHealth of their crossover claims may resubmit these claims on paper to MassHealth. Diagnosis Codes ICD-9-CM service codes are required on all claims. The ICD-9-CM service codes must be directly related to the service billed on the claim. Absorbent Products Providers are no longer required to submit a new prescription with the PA request when requesting a PA adjustment for a size change for absorbent products that have already been deemed medically necessary by MassHealth. Mobility System Repairs A prescription is not required for repairs of an already-approved mobility system, as long as the system is still medically necessary for the member for whom it was originally purchased. Service Codes not Covered by Medicare Providers that bill temporary national codes (non-Medicare) “S” codes, national “T” codes, and enteral products with a BO modifier are not required to bill Medicare and obtain an EOB to bill MassHealth. This also applies to all other service codes that are listed in the DME and Oxygen Payment and Coverage Guidelines Tool and that are also listed on Medicare’s 2010 Non- Covered Items list. Blanket Letters Before the implementation of NewMMIS, MassHealth would accept a “blanket letter” from Medicare stating that the item is not covered by Medicare. As of the date of the implementation of NewMMIS, MassHealth no longer accepts “blanket letters” from Medicare or any other payer when providers submit claims. Accreditation Providers must be accredited by an accrediting body that is acceptable to CMS. MassHealth Transmittal Letter OXY-29 May 2010 Page 3 Revised Rates DHCFP has established new rates for OXY Service Codes effective for dates of service beginning April 1, 2010. The DHCFP fee schedule and informational bulletins can be viewed on the DHCFP Web site at www.mass.gov/dhcfp. If you wish to obtain a fee schedule, you may download DHCFP regulations at no cost at www.mass.gov/dhcfp. If you wish to obtain a paper copy of the fee schedule, you may purchase DHCFP regulations from either the Massachusetts State Bookstore or from DHCFP (see addresses and telephone numbers below). You must contact them first to find out the price of the publication. The regulatory cite for Durable Medical Equipment and Oxygen and Respiratory Therapy Equipment is 114.3 CMR 22.00. Massachusetts State Bookstore State House, Room 116 Boston, MA 02133 Telephone: 617-727-2834 www.mass.goc/sec/spr Division of Health Care Finance and Policy Two Boylston Street Boston, MA 02116 Telephone: 617-988-3100 www.mass.gov/dhcfp If you have any questions about the information in this transmittal letter, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) Oxygen and Respiratory Therapy Equipment Manual Pages vi, 6-1, and 6-2 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Oxygen and Respiratory Therapy Equipment Manual Pages vi, 6-1 and 6-2 — transmitted by Transmittal Letter OXY-27 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title Table of Contents Page vi Oxygen and Respiratory Therapy Equipment Manual Transmittal Letter OXY-29 Date 04/01/10 6. Service Codes 601 Introduction......................................................................................................................... 6-1 602 Service Codes...................................................................................................................... 6-1 Appendix A. Directory ....................................................................................................................... A-1 Appendix B. Enrollment Centers ........................................................................................................ B-1 Appendix C. Third-Party-Liability Codes .......................................................................................... C-1 Appendix W. EPSDT Services: Medical Protocols and Dental and Periodicity Schedules.................. W-1 Appendix X. Family Assistance Copayments and Deductibles .......................................................... X-1 Appendix Y. EVS Codes/Messages ................................................................................................... Y-1 Appendix Z. EPSDT Services Laboratory Codes ................................................................................ Z-1 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6 Service Codes Page 6-1 Oxygen and Respiratory Therapy Equipment Manual Transmittal Letter OXY-29 Date 04/01/10 601 Introduction MassHealth pays for the services for codes listed in section 602 in effect at the time of service, subject to all conditions and limitations in MassHealth regulations at 130 CMR 427.000 and 450.000. In addition, a provider may request prior authorization (PA) for any medically necessary respiratory therapy equipment or service. Providers should consult Transmittal Letter OXY- 29 for the specific effective dates of service for the service codes. Providers should refer to the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool for service descriptions, applicable modifiers, place-of-service codes, PA requirements, service limits, and pricing and markup information. For certain services that are payable on an individual consideration (I.C.) basis, the Tool will calculate the payable amount, based on information entered into certain fields on the Tool. For service codes for which the Division of Health Care Finance and Policy (DHCFP) has established a rate, the provider can determine the payment by reviewing the DHCFP regulations at 114.3 CMR 22.00. The MassHealth DME and Oxygen Payment and Coverage Guidelines Tool also contains links to DHCFP regulations, MassHealth Guidelines for Medical Necessity Determination, and Part 6 of the administrative and billing instructions, which lists the error codes and explanations for claims that have been denied or suspended by MassHealth. To get to the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool, go to www.mass.gov/masshealth. Click on MassHealth Regulations and Other Publications, then on Provider Library, then on MassHealth DME and Oxygen Payment and Coverage Guidelines Tool. If you want a paper copy of the Tool, you can print it from the Web site, or request a copy from MassHealth Customer Service. See Appendix A of your provider manual for applicable contact information. 602 Service Codes A4216 A4217 A4481 A4483 A4556 A4557 A4558 A4605 A4606 A4608 A4611 A4612 A4613 A4614 A4619 A4623 A4624 A4625 A4626 A4627 A4628 A4629 A7000 A7001 A7002 A7003 A7004 A7005 A7006 A7010 A7011 A7012 A7013 A7014 A7015 A7017 A7018 A7025 A7026 A7027 A7028 A7029 A7030 A7031 A7032 A7033 A7034 A7035 A7036 A7037 A7038 A7039 A7044 A7045 A7046 A7501 A7502 A7503 A7504 A7505 A7506 A7507 A7508 A7509 A7520 A7521 A7522 A7523 A7524 A7525 A7526 A7527 E0424 E0431 E0434 E0439 E0445 E0450 E0457 E0459 E0460 E0461 E0463 E0464 E0470 E0471 E0480 E0482 E0483 E0484 E0500 E0550 E0560 E0561 E0562 E0565 E0570 E0572 E0585 E0600 E0601 E0605 E0606 E0619 E1372 E1390 E0487 K0730 K0738 L8501 S8185 S8186 S8210 S8999 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6 Service Codes Page 6-2 Oxygen and Respiratory Therapy Equipment Manual Transmittal Letter OXY-29 Date 04/01/10 This page is reserved.