Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 7 - DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND MEDICAL SUPPLIES (DMEPOS) › Section 471-7-005 - BILLING AND PAYMENT FOR DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND MEDICAL SUPPLIES (DMEPOS)

Current through June 17, 2024
005.01
BILLING.
005.01(A)
GENERAL BILLING REQUIREMENTS.
Providers must comply
  with all applicable billing requirements codified in 471 NAC 3. In the event
  that individual billing requirements in 471 NAC 3 conflict with billing
  requirements outlined in this chapter, the individual billing requirements in
  this chapter will govern.
005.01(B)
SPECIFIC BILLING REQUIREMENTS.
Providers must bill the
  Department on the appropriate claim form or electronic format. Any item billed
  to Medicaid must actually be dispensed or directly supplied by the provider
  that bills for the item. This does not preclude a provider from contracting
  with billing agents. Providers may not bill for durable medical equipment,
  prosthetics, orthotics, and medical supplies (DMEPOS) dispensed in advance.
005.01(B)(i)
PROCEDURE CODES AND
  MODIFIERS.
The provider will bill the Department using the
  Healthcare Common Procedure Coding System (HCPCS) and Current Procedural
  Terminology (CPT) procedure codes and modifiers.
005.01(B)(ii)
RENTAL BILLING
  PROCEDURES.
Providers must use the following rental billing
  procedures:
(1) Bill for rental only while the
  item continues to be medically necessary and appropriately used by the
  client;
(2) Rental items not used
  by the client for more than a one month period, during inpatient
  hospitalization, may not be billed to Medicaid. The provider is responsible for
  determining whether the item continues to be used by the client;
(3) Bill rental on a monthly basis unless the
  item is used for less than a one-month period. When billing for monthly rental,
  the unit of service "1" indicates a one-month rental period. The provider will
  use the appropriate procedure code modifier when billing for monthly rental.
  The beginning rental date for each month will be the day of the month on which
  the item was initially provided. A monthly rental period is not necessarily a
  calendar month or a standard number
(4) of days. The monthly billing period
  begins the day of rental and extends to the day prior to the corresponding
  numerical day the following month. When rental equipment is needed at any time
  by the client for less than a one-month rental period, the rental is paid on a
  daily pro-rated basis. The provider will use the appropriate procedure code
  modifier when billing for daily rental. The unit of service must reflect the
  number of days the item was actually used; and
(5) When billing for rental items, indicate
  both from and to dates of service and the initial rental date.
005.01(B)(iii)
USED
  ITEMS.
When billing for used durable medical equipment,
  prosthetics, orthotics, and medical supplies (DMEPOS) items, the provider must
  use the used equipment (UE) procedure code modifier.
005.01(B)(iv)
APNEA MONITOR
  SUPPLIES.
Apnea monitor supplies are covered for use with rented
  and client-owned apnea monitors. For rented apnea monitors, the apnea monitor
  supplies must be billed on the same claim as the apnea monitor
  rental.
005.01(B)(v)
HOME PHOTOTHERAPY.
The provider must bill for home
  phototherapy daily rental on a single claim and indicate the total number of
  rental days as the units of service.
005.01(B)(vi)
UTERINE MONITORS,
  HOME.
The provider must indicate on the claim the condition which
  necessitates use of the monitor and, when billing for the final rental period,
  the date of discontinuation of the monitor.
005.01(B)(vii)
OXYGEN
  THERAPY.
When billing for oxygen therapy, the durable medical
  equipment, prosthetics, orthotics, and medical supplies (DMEPOS) provider must
  use the appropriate unit of service as described in the procedure code. Units
  of service should be rounded to the nearest unit of the procedure code
  description.