Mich. Admin. Code R. 418.10913 - Billing for durable medical equipment and supplies
Rule 913.
(1)
DME and supplies must be billed using the appropriate descriptor from the HCPCS
Level II codebook, as referenced in
R 418.10107, for the service. If
the equipment or supply is billed using an unlisted or not otherwise specified
code and the charge exceeds $35.00, then the acquisition cost must be included
with the bill.
(2) Initial claims
for rental or purchased DME must be filed with a prescription for medical
necessity, including the expected time span the equipment is
required.
(3) Durable medical
equipment may be billed as a rental or a purchase. If possible, the provider
and carrier shall agree before dispensing the item as to whether it should be a
rental or a purchased item. With the exception of oxygen equipment, rented DME
is considered purchased equipment once the monthly rental allowance exceeds the
purchase price or payment of 12 months rental, whichever comes first.
(4) If the worker's medical condition changes
or does not improve as expected, then the rental may be discontinued in favor
of purchase.
(5) If death occurs,
rental fees for equipment terminates at the end of the month and additional
rental payments must not be made.
(6) The return of rented equipment is the
dual responsibility of the worker and the DME supplier. The carrier is not
responsible and shall not be required to reimburse for additional rental
periods solely because of a delay in equipment returns.
(7) Oxygen equipment must be considered a
rental as long as the equipment is medically necessary. The equipment rental
allowance includes reimbursement for the oxygen contents.
(8) A bill for an expendable medical supply
must include the brand name and the quantity dispensed.
(9) A bill for a miscellaneous supply, for
example, a wig, shoes, or shoe modification, must be submitted on an invoice if
the supplier is not listed as a healthcare professional.
Notes
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