Provider Notice issued 04/14/14

New Prior Approval and Claim Coding Instructions for All Wheelchair and Power-Operated Vehicle (POV) Repairs and Modifications Effective May 1, 2014

This notice informs durable medical equipment (DME) providers of new prior approval and billing requirements when requesting wheelchair and POV repairs and modifications.

In informational notices dated May 7, 2013 and September 11, 2013, HFS provided information regarding the implementation of the prior approval policy and the billing guidelines for wheelchair repairs while the department’s system was being modified. The system modifications are now complete, and the following policies are effective May 1, 2014. 

HFS 1409 Prior Approval Request Form “Pur/Rent” Codes

Providers must identify the appropriate procedure codes and complete the “Pur/Rent” field on the Prior Approval Request with one of the following codes. Providers must submit a Prior Approval Request for any repair to a manual or power wheelchair or POV that is patient-owned if the sum of the charges for the repairs is more than $400.00. 

P = Purchase

R = Rental

M = Modification

F = Repair

HFS 2210 Medical Equipment/Supplies Invoice

When billing an approved item on the paper HFS 2210 Medical Equipment and Supplies Invoice, providers must report the prior approval number in the Prior Approval Number field for each service section completed. Providers must enter the last eight digits of the prior approval number, since this field will only accommodate eight digits. The department’s system will add the first two digits when editing the field. The HFS 2210 “Pur/Rent” field must also identify the appropriate code as noted below:

837P Electronic Claim Format

For the electronic 837P, providers must enter all 10 digits of the Prior Approval number. The electronic claim must also identify the appropriate procedure code and modifier as noted below:

DME Fee Schedule

The DME Fee Schedule format has also been changed. The Prior Approval indicator of “E” indicates prior approval is required for purchases and modifications, and also for repairs when the repair charges exceed $400.00. The prior approval indicator of “B” means that prior approval is required and the item will be rented to meet purchase price.  

Any questions regarding this notice may be directed to a DME billing consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565, option 3, option 2.

Theresa A. Eagleson, Administrator

Division of Medical Programs