LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2013-08 MM8390 Related Change Request # CR8390

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LEEDerGroup.com

MLN Matters®
Number: MM8390 Related Change Request (CR) #: CR8390
Related CR Release Date: August 2, 2013 Effective Date: October 5, 2013
Related CR Transmittal #: R2755CP Implementation Date: October 5, 2013
Additional States Requiring Payment Edits for DMEPOS Suppliers of Prosthetics and Certain Custom-Fabricated Orthotics. Update to CR 3959

  • Provider Types Affected
    This MLN Matters® article is intended for suppliers in Alabama, Arkansas, Florida, Georgia, Illinois, Kentucky, Mississippi, New Jersey, Ohio, Oklahoma, Rhode Island, Tennessee, Texas, and Washington , , who bill Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for Prosthetics and Orthotics (P&O) provided to Medicare beneficiaries.
  • Provider Action Needed
    This article is based on Change Request (CR) 8390 which instructs DME MACs to revise programming edits so that Arkansas, Georgia, Kentucky, Mississippi, and Tennessee are added to the logic, in accordance with CR3959 (Transmittal 656; August 19, 2005). CR3959 instructed DME MACs to implement claims processing edits to ensure compliance with CMS regulations which require Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers wishing to bill Medicare to operate their business and furnish Medicare-covered items in compliance with all applicable Federal and State licensure and regulatory requirements. At the time CR3959 was issued and DME MACs implemented the edit, there were nine (9) states (including Alabama, Florida, Illinois, New Jersey, Ohio, Oklahoma, Rhode Island, Texas, and Washington) which required the use of a licensed/certified orthotist or prosthetist for furnishing of orthotics or prosthetics. Since that time, five
    (5) additional states have instituted requirements for the use of a licensed/certified orthotist or prosthetist for furnishing of orthotics or prosthetics. CR8390 instructs DME MACs to revise programming edits so that the five additional states including Arkansas, Georgia, Kentucky, Mississippi, and Tennessee are added to the logic, in accordance with CR3959.
    See the Background and Additional Information Sections of this article for further details, and make sure that your billing staffs are aware of these changes.
  • Background
    The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 3959 (Transmittal 656) on August 19, 2005, which instructed DME MACs to implement claims processing edits to ensure compliance with CMS regulations found at 42 CFR 424.57©(1). Such regulations require DMEPOS
    suppliers wishing to bill Medicare to operate their business and furnish Medicare-covered items in compliance with all applicable Federal and State licensure and regulatory requirements.You can find the MLN Matters® article (MM3959) corresponding to CR3959 at
    http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/MM3959.pdf on the CMS website. You can also review 42 CFR § 424.57©(1) at http://www.ecfr.gov/cgi-bin/textidx?c=ecfr&SID=5f8d8d2cda131ddbf2c2e24b532cce14&rgn=div8&view=text&node=42:3.0.1.1.1
    1.4.5.8&idno=42 on the Internet.
    CR8390 instructs DME MACs to revise programming edits so that Arkansas, Georgia, Kentucky, Mississippi, and Tennessee are added to the logic, in accordance with CR3959. You can review the
    list of Healthcare Common Procedure Coding System (HCPCS) codes for customized orthotics and prosthetics affected by edit. That is attached to CR3959 at http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/downloads/r656cp.pdf on the CMS website.
  • Additional Information
    The official instruction, CR8390, issued to your DME MACs regarding this change may be viewed at http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/Downloads/R2755CP.pdf on the CMS website.
    If you have any questions, please contact your DME MACs at their toll-free number, which may be found at http://www.cms.gov/Research-Statistics-Data-and-Systems/MonitoringPrograms/provider-compliance-interactive-map/index.htmlon the CMS website.