Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 17 - MEDICAL SUPPLIERS › Section 317:30-5-211.5 - Repairs, maintenance, replacement and delivery

Current through Vol. 41, No. 20, July 1, 2024
(a)
Repairs.
Repairs to
				  equipment that either the Oklahoma Health Care Authority (OHCA) or a member
				  owns are covered when they are necessary to make the equipment usable. The
				  repair charge includes the use of "loaner" equipment as required. If the
				  expense for repairs exceeds the estimated expense of purchasing or renting
				  another item of equipment for the remaining period of medical need, payment
				  cannot be made for the amount in excess. Repairs of rented equipment are not
				  covered.
(b)
Maintenance.
Routine periodic servicing, such as testing,
				  cleaning, regulating, and checking the member's equipment is considered
				  maintenance and not a separate covered service. DME suppliers must provide
				  equipment-related services consistent with the manufacturer's specifications
				  and in accordance with all federal, state, and local laws and regulations.
				  Equipment-related services may include, but are not limited to, checking oxygen
				  system purity levels and flow rates, changing and cleaning filters, and
				  assuring the integrity of equipment alarms and back-up systems. However, more
				  extensive maintenance, as recommended by the manufacturer and performed by
				  authorized technicians, is considered repairs. This may include breaking down
				  sealed components and performing tests that require specialized testing
				  equipment not available to the member. The supplier of a capped rental item
				  that supplied the item the thirteenth (13 th) month must provide maintenance
				  and service for the item. In very rare circumstances of malicious damage,
				  culpable neglect, or wrongful disposition, the supplier may document the
				  circumstances and be relieved of the obligation to provide maintenance and
				  service.
(c)
Replacement.
(1) If equipment
				  that has met the capped rental period and has been in continued use by the
				  member for the equipment's useful life or if the item is irreparably damaged,
				  lost, or stolen, a prior authorization must be submitted to obtain new
				  equipment. The reasonable useful lifetime for capped rental equipment cannot be
				  less than five (5) years. Useful life is determined by the delivery of the
				  equipment to the member, not the age of the equipment.
(2) Replacement parts must be billed with the
				  appropriate Healthcare Common Procedure Coding System (HCPCS) code that
				  represents the item or part being replaced along with a pricing modifier and
				  replacement modifier. If a part that has not been assigned a HCPCS code is
				  being replaced, the provider should use a miscellaneous HCPCS code to bill each
				  part. Each claim that contains miscellaneous codes for replacement parts must
				  include a narrative description of the item, the brand name, model name/number
				  of the item, and an invoice.