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CMS Releases IFR-Mandated Rural Reimbursement Adjustments
On Thursday, CMS published new adjusted rates for rural areas and non-contiguous states as mandated by the
recently-released Interim Final Rule
(IFR). AAHomecare's analysis shows that they are consistent with the examples CMS published in their
fact sheet
on the IFR.
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HCPCS
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DESCRIPTION
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JAN. 2018 RATE
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IFR
ADJUSTMENT
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%
CHANGE
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E0277
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LOW AIR LOSS MATRESS
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$ 205.41
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$ 438.56
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114%
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E0601
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CPAP
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$ 43.95
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$ 73.87
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68%
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E1390
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OXYGEN CONCENTRATOR
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$ 77.16
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$ 121.46
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57%
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E2402
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NPWT PUMP
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$ 703.16
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$ 1,184.12
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68%
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K0003
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MANUAL WHEELCHAIR
LIGHT WEIGHT
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$ 36.73
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$ 66.62
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81%
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Medi-Cal Provider Updates
This first article indicates that Medi-Cal will follow changes adopted by Noridian for Medicare claims.
2. Modifiers Added or Revised for Select Oxygen System Codes
Effective for dates of service on or after April 1, 2018, modifiers for select oxygen system HCPCS codes have been added or revised as part of the HCPCS quarterly updates.
As presented in the following table, new modifiers QA, QB and QR have been added as approved modifiers, and the long descriptors for current modifiers QE, QF and QG have been revised:
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Modifier
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Description
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QA
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Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than one liter per minute (LPM)
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QB
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Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds four LPM and portable oxygen is prescribed
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QE
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Prescribed amount of stationary oxygen while at rest is less than one LPM. The reimbursement amount is reduced by 50 percent
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QF
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Prescribed amount of stationary oxygen while at rest exceeds four LPM and portable oxygen is prescribed
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QG
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Prescribed amount of stationary oxygen while at rest is greater than four LPM
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QR
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Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds four LPM
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These modifiers are billable only with the following HCPCS codes:
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HCPCS Code
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Description
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E0424
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Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator; flowmeter, humidifier, nebulizer, cannula or mask, and tubing
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E0439
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Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing
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E1390
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Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate
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E1391
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Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each
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No action is required of providers. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC).
This article provides official notification on retroactive changes to some DME codes many related to wheelchairs and accessories. There were pricing changes on these codes implemented on 10/1/17 that CAMPS contacted DHCS about and to complain about the magnitude of the reductions. They were allegedly based upon Medicare rate changes but they did not seem to have any valid relationship to Medicare rates, fee schedule or CB. We were able to get some of the codes adjusted upward. The changes are retroactive to 10/1/17 and there will be an EPC to automatically reprocess the impacted claims.
3. Updated Reimbursement Rates for Select DME Codes
Effective retroactively for dates of service on or after October 1, 2017, the rental and/or purchase reimbursement rates for the following Durable Medical Equipment (DME) codes are updated:
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E0140
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E1020
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E2228
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K0044
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K0070
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E0149
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E1028
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E2368
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K0045
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K0071
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E0197
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E2206
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E2369
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K0046
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K0072
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E0955
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E2220
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E2370
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K0047
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K0073
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E0967
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E2221
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E2375
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K0050
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K0077
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E0985
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E2222
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K0042
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K0051
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K0098
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E0995
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E2224
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K0043
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K0052
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An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required of providers.
For more information, providers may refer to the Medi-Cal Rates page on the Medi-Cal website.
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One Capitol Mall, Suite 800
Sacramento, CA 95814
t: (916) 443-2115
f: (916) 444-7462
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