Provider Notice issued 06/15/12

DME Supplies to be Billed Through Pharmacy System Effective July 1, 2012

Effective with dates of service on and after July 1, 2012, the department will shift certain supply codes from the DME Fee Schedule to the pharmacy billing system. These supply codes have been contained in the DME Fee Schedule, but after review by the department, have been determined to be most appropriately submitted through the pharmacy billing system. The codes will be removed from the DME Fee Schedule.

DME providers who are not also enrolled to provide pharmacy services cannot be reimbursed for these supplies for any service date after June 30, 2012. It is extremely important for these DME providers to identify any patient receiving one of the designated supplies who has a current prior approval that spans July 1, 2012. For dates of service on and after July 1, 2012, the patient must obtain the item from another provider who is enrolled to provide pharmacy services. 

The department has posted to its Web site a document, "DME Supplies Required to be Billed Through the Pharmacy System", that identifies the specific codes that are being removed from the DME Fee Schedule. Providers who attempt to bill these supply codes through the DME billing system for a date of service beyond June 30, 2012, will receive rejection message C16 – Procedure Not Covered for Illinois Medical Assistance. Providers enrolled for pharmacy services can rebill through the pharmacy billing system using the item’s eleven-digit NDC.

Please note, the department will continue to process secondary claims for Medicare Part B eligible patients through the DME processing system.

Any questions regarding this notice may be directed to a pharmacy billing consultant in the Bureau of Pharmacy Services at 877-782-5565, option 7.

Theresa A. Eagleson, Administrator

Division of Medical Programs