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Department of Human Services Department of Human Services  
 
Equipment and Supplies

Revised: 06-09-2014


Airway Clearance Devices
Ambulatory Assist Equipment
Apnea Monitors
Augmentative Communication Devices
Bath and Toilet Equipment
Breast Pumps
Bone Growth Stimulators
Diabetic Equipment and Supplies
Electrical Stimulation Devices
External Defibrillators
Gloves
Hearing Aids
Hospital Beds
Humanitarian Use Devices
Incontinence Products
Infusion Pumps
Lower Limb Prosthetics
Miscellaneous Codes
Miscellaneous Products
Mobility Devices
Nebulizers
Non-Mobility Equipment Repairs
Nutritional Products
Orthopedic and Therapeutic Footwear
Orthotics
Oximeters
Oxygen Equipment
Patient Lifts and Seat Lift Mechanisms
Positioning Equipment
Pneumatic Compression Devices
Positive Airway Pressure for Treatment of Obstructive Sleep Apnea
Pressure Reducing Support Surfaces
Prosthetics and Orthotics
Respiratory Assist Devices (Suitable for 12 Hrs or Less Per Day)
SAD Lights
Specialized Wound Treatment Technology
Spirometers
Standers
Suction Pump (Respiratory)
Topical Products Defined as Drugs
Transcutaneous Electrical Nerve Stimulator (TENS)
Ultraviolet Light Therapy Systems
Urological Supplies
Ventilators
Wigs

Eligible Providers

To be eligible to enroll as a medical supplier, a provider must purchase medical equipment and or supplies for sale or rental to the general public. The provider must be able to perform or arrange necessary repairs and maintenance to equipment offered for sale or rental. The following are eligible medical supply providers:

• Federally Qualified Health Centers
• Home health agencies
• Indian Health Services
• Medical suppliers (including oxygen contract vendors)
• Pharmacies
• Rural Health Clinics

The following are eligible providers for medical equipment and supplies only when the medical equipment and supplies are provided as a necessary adjunct to the direct treatment of a recipient's condition (e.g., crutches, splints) and not incident to the service provided.

• Clinics
• Clinical nurse specialists
• Hospital outpatient facilities
• Nurse practitioners
• Physician assistants
• Physicians
• Podiatrists

TPL and Medicare
Providers must meet any provider criteria, including accreditation and surety bond requirements, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer. Providers who do not meet Medicare requirements must refer and document the referral of dual eligible recipients to Medicare providers when Medicare is determined to be the appropriate payer for services including supplies and equipment.

Providers who do not meet provider criteria for the primary payer will not be reimbursed by MHCP.

If Medicare downcodes an item, MHCP must make payment based on the downcoded Medicare EOB, regardless of any MHCP prior authorization. Providers may choose to offer only Medicare-covered equipment to dual eligible recipients if a Medicare Local Coverage Determination states that specific items will be downcoded.

Provider Type Home Page Links
Review related Web pages for the latest news and additions, forms, and quick links.

Eligible Recipients

All eligible MHCP recipients. Exceptions to coverage indicated in the Programs and Services section of this manual or in the coverage policy page for specific items.

Covered Services

MHCP covers medical supplies and equipment, subject to limitations, authorization, and other requirements. Additional restrictions apply to supply and equipment coverage for recipients residing in long term care (LTC) facilities.

• When the medical equipment or supply is purchased for a recipient, the item is the recipient's property
• Rent for most durable medical equipment is covered up to 13 months, or to the purchase price of the equipment. After 13 months of rental or when the purchase price is reached, the item is the recipient’s property
• Durable medical equipment determined by Medicare to require frequent and substantial servicing is not subject to the 13 month / purchase price rental limit
• MHCP assumes a reasonable useful lifetime of five years for all durable medical equipment
• MHCP will not cover equipment that serves the same purpose as usable equipment previously purchased for the recipient
• MHCP covers repairs to medically necessary recipient-owned equipment and maintenance on equipment that requires frequent cleaning and/or routine calibration to ensure proper working order
• All purchased equipment must be new upon delivery to the recipient. Equipment that is intended to rent until converted to purchase must be new equipment. Used equipment may be used for short-term rental, but if eventually converted to purchase, must be replaced with new equipment.

To determine the appropriate HCPCS code to use with a covered service, access the Medicare Pricing, Data Analysis and Coding (PDAC) Product Classification List.

Refer to the Medical Supply Coverage Guide (PDF) (also available in an Excel format) for information about coverage and limits for supplies and equipment not included in this manual.

Living Arrangement Codes
Refer to the above guides for services that may be affected by living arrangement.

41: NFI (Nursing Facility I) Medicare Cert
42:
NFII (Nursing Facility II) Non-Medicare Cert
43:
Intermed CR Facility-Developmental Disabilities Pub/Priv
44:
Short Term Stay NFI
45:
Short Term Stay NFII
46:
Short Term Stay ICF-DD
48:
Medical Hospital
55:
Rule 203 - Adult Foster Home
80:
Community


Correct Coding Initiative
MHCP has implemented National Correct Coding Initiative (NCCI) edits. Two types of NCCI edits exist and apply to durable medical equipment, medical supplies, prosthetics and orthotics:

• Code-to-code edits that define pairs of HCPCS/CPT codes that should not be reported together
• Medically Unlikely Edits (MUEs) or units-of-service edits that define for each HCPCS/CPT code the number of units of service beyond which the reported number of units is unlikely to be correct

When an authorization is required for an item, an appropriate NCCI modifier may be added to the authorization request and entered on the claim.

An Authorization for an item that does not require authorization cannot bypass a NCCI edit. If the NCCI should not apply to the claim select the appropriate modifier and report it on the claim to bypass a NCCI edit.

Review the Minnesota NCCI FAQs page available on the MHCP Provider website for additional information.

Coverage Criteria


Infusion Pumps
Stationary and Ambulatory Infusion Pumps
Codes: E0779 (rental only), E0780 (purchase only), or E0781 (rental or purchase)

Authorization is not required.

Document the following in the recipient’s file at the medical supplier’s office:

The physician's order must include the length of need (number of days per month and/or total number of months), diagnosis, name of drug, frequency of administration, and a copy of the treatment plan.

Enteral and Parenteral Nutrition Infusion Pumps
Codes: B9000, B9002, B9004, B9006, E0791

Authorization is required for maintenance service only.

Document the following in the recipient’s file at the medical supplier’s office:

The physician's order, which must include:

• A copy of the treatment plan
• Diagnosis
• Frequency of administration
• Length of need (number of days per month and/or total number of months)
• Name of drug

Miscellaneous Codes
Use the most specific HCPCS code for the item being dispensed. Do not use miscellaneous codes for the sole purpose of trying to receive higher reimbursement.

MHCP accepts the following miscellaneous HCPCS codes:

Procedure Code Description Usage Prior Authorization Requirements
E1399 Durable Medical Equipment, Misc. Use for durable medical equipment that does not have a specific code and only for the entire piece of equipment, not parts. Over $400 and specific items listed in chapter
A9999 Miscellaneous DME Supply or Accessory, Not Otherwise Specified Use for an accessory or an added on part to a piece of DME that has no code, not the entire piece of equipment, just a part of it. Over $400
T5999 Supply, Not Otherwise Specified Use for disposable supplies that do not fit into any of the other more specific miscellaneous supply codes. None
S8189 Tracheostomy Supply, Not Otherwise Classified Use for miscellaneous tracheostomy supplies only None
A4649 Surgical Supply, Miscellaneous Use for miscellaneous wound care supplies and items related to surgical procedures Over $400 and specific items listed in chapter
A4335 Incontinence Supply, Miscellaneous Use for supplies (with no specific HCPCS code) relating to urinary or fecal incontinence None
A4421 Ostomy Supply, Miscellaneous Use for any miscellaneous supplies for ostomies in the colon, ileum, abdomen, etc. (use S8189 for tracheostomies). None
B9998 Enteral Supplies, Not Otherwise Classified Use for supplies relating to enteral nutrition. None
B9999 Parenteral Supplies, Not Otherwise Classified Use for supplies relation to parenteral nutrition None

Billing Miscellaneous Codes
When billing for multiple products that are different but require the use of the same miscellaneous HCPCS code, use the correct miscellaneous code and modifier for the first line item, and add the 76 modifier to each additional line using the same miscellaneous HCPCS code. If billing multiple units of the same product, bill using the correct miscellaneous code and modifier and indicate the number of units dispensed.

The following miscellaneous HCPCS/Procedure codes will be automatically priced if the correct description of the product is entered on the notes field on the Services tab in MN–ITS for each line item.

A7520, A7521, and B4088 require the use of the NU modifier for auto pricing at the fee schedule rate. For auto pricing of specialized items, enter the appropriate HCPCS code with the U3 modifier and the long description.

A4335, A4421, A4649, A9999, B9998 and S8189 require the use of the NU modifier and the long description for auto pricing.


Miscellaneous Products
Sharps Disposal Containers
Recipients who self-administer medications using syringes may receive sharps disposal containers. Bill using A4211 and modifier U3 along with appropriate pricing information as outlined in the Billing Policy section.

QR Powder/Nosebleed QR/WoundSeal
Code: A4649 NU
WoundSeal Powder,QR Powder for lacerations, QR Powder for Kid’s Cuts and Scrapes, QR Powder for Nosebleeds, and Gentle Formulation QR Powder for Nosebleeds are covered when prescribed by a physician for recipients with bleeding disorders, including bleeding disorders caused by use of anticoagulants. The claim must include a diagnosis code specific to the bleeding disorder. Up to 4 units may be dispensed in anticipation of future need. It is not necessary to open packaging; providers may dispense a box of 2 or 4 applications. 1 unit = 1 application.

EarPopper
Code: E1399 NU
EarPopper Home Version is covered when prescribed by a physician for recipients over age 3 with otitis media with effusion or eustachian tube dysfunction who are unable to independently perform the Politzer maneuver.


Nebulizers
Codes:
E0570 (with Compressor (Pulmo Aide Type)
E0571 (Portable with small compressor with limited flow: battery operated) for dates of service prior to 1/1/2012

Authorization is not required.

One nebulizer is allowed every 5 years, if more than allowed quantity is medically necessary, providers must submit a claim with an attachment explaining the circumstances requiring replacement.

Document the following in the recipient’s file at the medical supplier’s office.

The need for a battery operated model (why a portable electric model does not meet the medical needs of the recipient) must be documented, and:

• Previous life threatening bronchospasms
• Aerosol drug therapy is more frequent than twice per day for a recipient who is away from home at school or work on a daily basis
• Cystic Fibrosis or
• Bronchiectasis

Included in Initial Dispensing:

• Compressor
• Mask
• Mouthpiece
• Reusable nebulizer
• Tubing

Separately Bill:

• Disposable mouthpieces
• Face mask
• Replacement of disposable hand held nebulizer
• Replacement tubing

Prosthetics and Orthotics
Refer to the following sections:
Lower Limb Prosthetics

Orthopedic and Therapeutic Footwear

Orth
otics

Physiatrist: A physician who specializes in physical medicine or who possesses specialized knowledge of rehabilitation and who is certified by the American Board of Physical Medicine and Rehabilitation.

Prosthetic or Orthotic Device: An artificial device, as defined by Medicare, to replace a missing or nonfunctional body part, to prevent or correct a physical deformity or malfunction, or to support a deformed or weak body part.

Criteria:
A prosthetic or orthotic must be prescribed by:

• A physician who is knowledgeable in orthopedics or physiatrists
• A physician in consultation with an orthopedist, physiatrist, physical therapist, or occupational therapist or
• A podiatrist within the scope of their profession. MHCP covers podiatrist services to treat below the knee

Authorization is required when:

• Required by a specific policy
• Miscellaneous prosthetic/orthotic codes total billing over $400

Implantable Prosthetics L8609, L8614, and L8619 always require authorization.

Requests for authorization
Submit authorization requests through MN–ITS (Authorization Request 278). Fax the MN–ITS response with the required documentation, physician’s orders and appropriate additional information to the Authorization Medical Review Agent. Write the MN–ITS Authorization Request number on each page of each document.

• Submit the prosthetic base HCPCS code on the first line of the authorization request if a new prosthetic is being requested. Do not submit the base code if repairs are requested.
• List all add-on items on separate lines on the authorization request, even if the individual item does not require authorization. List each item by HCPCS code, appropriate modifier, quantity, and charge
• MHCP will not authorize more units per line than are allowed by Medicare’s Medically Unlikely Edits (MUEs). When requesting authorization for bilateral prosthetics or orthotics where more units are required than are allowed by the MUEs, the units must be requested on different lines, with modifiers NU RT and NU LT as appropriate.
• When multiple items that are different but require the same miscellaneous code are requested, each item must be listed on a separate line of the authorization request. A unique description of each item must be entered into the model number field for each line. The unique description may be a model number or narrative description up to 20 characters
• Documentation for purchase must address the recipient’s medical need, and how the requested prosthetic meets that need. Although all add-ons/accessories must be listed on the request, only the major components will be reviewed for medical necessity.
• Each line will be approved or denied, with the allowed dollar amount listed if approved.

Billing for items not requiring authorization
• Submit the usual and customary charge for each line, not the approved amount from the authorization letter. Payment will be the balance of the lesser of the billed amount or the approved amount, after any primary or secondary payers have made payment.
• Bill repairs to prosthetics/orthotics with the appropriate HCPCS code representing the item and the modifier RB. The charges represent the materials necessary to accomplish the repair. Bill replacement of parts using the HCPCS code representing the replacement part, and the NU or RA modifier to indicate the item is a purchase.
• When billing labor, specify the number of units of labor and the hourly rate. Do not bill for setup and delivery, or for service calls that do not involve actual labor time for repairs.
• MHCP will not pay claims for more units per line than are allowed by Medicare’s Medically Unlikely Edits (MUEs). When billing for bilateral prosthetics or orthotics where more units are required than are allowed by the MUEs, the units must be billed on different lines, with modifiers NU RT and NU LT as appropriate.

Billing for items approved on a multi-line authorization
Submit one claim for the approved base and all approved add-ons/accessories. Make sure the HCPCS codes, modifiers and descriptions on the claim match the same information on the prior authorization.

Enter the authorization number in the authorization field for each line.

When the model number field is used, do not use the Notes field on the Services tab. Use the Claim Notes field on the Claim Information tab.

Prosthetic and orthotic devices for which fabrication has begun, but has not yet been completed as of the date of the recipient’s termination from MHCP eligibility, will be reimbursed on a prorated basis.


Respiratory Assist Devices (Suitable for 12 Hours or Less per Day)
Codes: E0470, E0471, E0472

Authorization is required only for maintenance service agreements.

Document one of the following diagnoses in the recipient’s file at the medical supplier’s office:

• Chronic obstructive pulmonary disease
• Central sleep apnea
• Obstructive sleep apnea
• Neuromuscular respiratory insufficiency
• Thoracic deformity which inhibits respiration
• Idiopathic or central hypoventilation syndrome
• Post polio syndrome
• Other diagnosis which requires ventilation assistance for 12 hours or less for the spontaneously breathing recipient

Included with Rental:

• Carrying case
• Compressor unit
• Filters
• Fuses
• Instruction manual
• Power cord
• Permanent circuit
• Swivel adapters

Separately Bill:

• Headgear
• Humidification device
• Mask

Suction Pump (Respiratory)
Code: E0600

Authorization is not required.

A portable suction pump may be used as a stationary suction. MHCP will not cover both portable and stationary suction pumps unless documentation supports the need for both types.

Included with Purchase/Rental:

• Battery
• Battery charger
• Carrying case
• Overflow valve
• Permanent collection bottles
• Pump

Separately Bill:

• Connecting tubing
• Disposable collection bottles
• Suction catheters.

Do not bill for both a portable and a stationary suction pump on the same date of service.,


Topical Products Defined as Drugs
Skin care products classified as drugs and provided for recipients with catheters, ostomies, or other conditions may be covered only under the following circumstances:

• The item must be produced by a manufacturer that has a rebate agreement with the CMS
• The pharmacy provider must submit the claim electronically using the 11-digit National Drug Codes (NDC). State law does not allow medical equipment and supply providers or home health care agencies to provide items that meet the definition of a drug).

The following items are defined as drugs and may be covered only as described above. This is not an inclusive list. Not all products that fit into one of the categories listed below are covered. Call the Provider Call Center at (651) 431-2700 or 1-800-366-5411 to verify drug coverage using the NDC.

• Aluminum acetate solution and lime sulfur dressing and soaks
• Aluminum chloride, fluorouracil, and hydroquinone solutions
• Anti-acne medications
• Antibiotic-steroid combinations
• Antifungal compounds
• Anti-psoriasis and anti-eczema medications;
• Antiseptics
• Burn anti-infective agents
• Enzymes
• Lactic acid lotion
• Scabicides and pediculicides
• Sterile saline or water (includes irrigation solutions labeled as Rx legend)
• Topical anesthetic and antipruritic solutions
• Topical anti-infective agents and cleaners
• Topical corticosteroid
• Urea solutions
• Vitamin A & D ointments
• Wart medications
• Zinc oxide compounds

Non-Topical Products: Lubricants for ostomy recipients, non-legend sterile saline irrigation solutions, skin barriers, and other topical products that do not contain active ingredients and are not classified as drugs may be billed using MN–ITS 837P Professional claim with the appropriate HCPCS code. These items require a written order from the physician that includes the exact description of the product to be dispensed, the amount needed, and the length of time needed.


Wigs
Code: A9282

Authorization is not required.

Criteria: Diagnosis of alopecia areata only. MHCP will cover one wig per 366 day period (one year plus one day).

Non-Covered Services

• The following list of non-covered services is not all-inclusive:
• Air conditioners
• Bathroom scales
• Bathtub wall rails
• Beds - oscillating and lounge beds, bed baths and lifters, bedboards, tables, and other bed accessories
• Blood glucose analyzer - reflectance colorimeter
• Car seats, standard use
• Cervical roll or pillow
• Clothing
• Control units and battery device adapters
• Dehumidifiers - room or central
• Diathermy machines
• Disposable wipes - including Attends wash cloths
• Disposable ice packs/disposable heat wraps
• Elevators and stair lifts
• Enuresis or bed-wetting alarms
• Environmental products (e.g., air filters, purifiers, conditioners, hypoallergenic bedding, and linens)
• Exercise equipment
• Food blenders
• Grab bars
• Heat and massage foam cushion pads
• Home security systems
• Household equipment and supplies such as ramps, switches, tableware, and feeding instruments
• Humidifiers - room type or central
• Hygiene supplies and equipment, including hand-held shower units and shower trays, and dental care supplies and equipment
• Incontinence undergarments (includes pants to wear with pads)
• Instructional materials (e.g., pamphlets and books)
• Isolation gowns, surgical gowns, and masks
• Magnifying glasses
• Massage devices
• Medical alert bracelets and response systems
• Medical supplies defined as drugs
• Menses products (e.g., sanitary pads)
• Motorized lifts for a vehicle
• Orthopedic mattresses
• Personal computers and printers, tape recorders, or video recorders
• Pulse tachometers
• Ramps
• Reachers
• Reading glasses
• Saline or other solutions for the care of contact lenses
• Table foods
• Telephones, telephone alert systems, telephone arms, or answering machines
• Tennis/gym shoes
• Thermometer covers
• Toothbrushes and toothettes
• Toys
• Waterbeds
• White canes for the blind

Billing and Documentation

Follow the general billing information in the Billing Policy section of the manual. Additional information about billing of specific items can be found in the policy section for those items. The Medical Supply Coverage Guide (PDF) may have additional information.


Provider Initiated Upgrades
Medical equipment that has features that go beyond what is medically necessary are considered upgrades. Providers may choose to supply upgraded equipment but charge MHCP for the non-upgraded item. The reason for this may be that the provider chooses to carry only upgraded equipment in order to reduce the costs of maintaining a broader inventory of models or replacement parts. Upgrades must be medically appropriate for the recipient’s medical condition and the purpose of the physician’s orders. Examples of upgrades include a power wheelchair for a member for whom a manual wheelchair is medically necessary and sufficient or a standard hospital bed with a mahogany headboard and footboard rather that a plastic headboard and footboard.

The recipient may not be billed for the provider initiated upgrades. If the provider chooses to supply upgraded equipment, the provider chooses to accept the MHCP for the non-upgraded item as payment in full.

When billing for a provider initiated upgraded item, the claim must include only the charge and the HCPCS code for the non-upgraded item. The HCPCS code for the non-upgraded item must be accompanied by the GL modifier (medically unnecessary upgrade provided instead of the standard item, no charge). In the narrative field of the claim, specify the make and model of the item actually furnished, and describe why the item is an upgrade.

If prior authorization is needed for the non-upgraded item, submit the request for the HCPCS code of the non-upgraded item, using the GL modifier. Include all required documentation for the medically necessary (non-upgraded) item, and specify the make and model of the item that will actually be furnished. Describe why this item is an upgrade.

If repairs are needed to a provider initiated upgraded item, MHCP will only pay for the repairs that might reasonably be required if the non-upgraded item had been provided unless the upgraded item is now medically necessary. For example, if a standard hospital bed was ordered and a semi-electric bed was provided as a provider initiated upgrade, MHCP will pay for repairs to a broken caster, but would not reasonably require repair to a motor. If there has been a change in the recipient’s condition, so that the semi-electric bed in now medically necessary, MHCP will pay for the repairs. If the repair would not be reasonably required by the medically necessary item, the provider must repair the upgraded item but cannot bill MHCP or the recipient for the repairs.

Prior authorization is required for all repairs when parts and labor total over $400 for DME other than wheelchairs. Prior authorization is required for all repairs to wheelchairs when parts and labor total over $1000, or when parts to be replaced are less than one year old. Submit the request using the HCPCS code for the non-upgraded item, using the GL modifier, and the NU/RP/RA/RB modifiers as appropriate. Include documentation of the make and model of the upgraded item. If the repair would be reasonable required by the medically necessary item, submit documentation sufficient to show this. If the upgraded item is now medically necessary, submit all documentation about the required repair.


Authorization Requirements
The provider must obtain authorization when required. Refer to the Coverage Criteria for specific HCPCS codes within this section of the MHCP Provider Manual or the Medical Supply Coverage Guide (PDF) (also available in an Excel format).

Medical supply providers requesting authorizations may use MN–ITS Interactive Medical Supply Authorization Request or the MHCP Authorization Form (DHS-4695).

The provider may not request or accept payment from the recipient for any service for which the required authorization was not obtained.


Documentation
Supplier Documentation
The medical supplier must have the following information on file:

• The dispensing order
• The original detailed written order
• Recipient's diagnosis from the testing physician
• Any information required for use of specific modifiers or attestation statements
• Adequate information to assure that coverage criteria for an item have been met
• Information in the medical record must adequately support the medical necessity for the item, or the supplier is liable for the dollar amount involved
• Proof of delivery documentation

Provide proof of delivery in any of the following methods:
Method 1: Supplier delivers items directly to the recipient or authorized representative
• The delivery slip must be signed and dated by the recipient or authorized representative to verify the DME/supply item was received
• The date of the signature on the delivery slip must be the date DME/supply was received by the recipient or authorized representative
• The delivery slip must include the recipient's name, quantity, a detailed description of the item(s) delivered, brand name, and serial number (if applicable)
• The date of service on the claim must be the date the DME/supply item was received by the recipient or authorized representative.
• Date of service exception: if the DME item is delivered to a recipient in a hospital up to two days prior to discharge (home) and for the benefit of the recipient for the purpose of fitting or training of the recipient in its use, the supplier must bill the date of service on the claim as the date of discharge (home) and must use place of service "12" (home)

Method 2: Supplier delivers certain items without the recipient’s signature of receipt

• For medical supplies that are not vulnerable to damage by weather, and which do not require fitting or training, the recipient or authorized representative may consent in advance to waive in-person signature.
• The consent must be in writing, and must specify a preferred location at the recipient’s residence for supplies to be left
• The delivery slip must be signed by the person delivering the goods, and must specify the date, time and place of delivery
• The delivery slip must include the recipient’s name, a detailed description of the item(s) delivered, quantity, brand name and serial number (if applicable)
• MHCP will not pay for items reported damaged or missing. Providers are encouraged to talk to their insurers to discuss liability for replacing items if a recipient reports the product damaged or missing
• The date of service on the claim must be the date on the delivery slip
• Date of service exception: if the DME item is delivered to a recipient in a hospital up to two days prior to discharge (home) and for the benefit of the recipient for the purpose of fitting or training of the recipient in its use, the supplier must bill the date of service on the claim as the date of discharge (home) and must use place of service "12" (home)

Method 3: Supplier uses a delivery/shipping service to deliver items

• Acceptable proof of delivery includes the delivery service's tracking slip and the supplier's shipping invoice
• The supplier's shipping invoice must include the recipient's name, quantity, detailed description of the item(s) delivered, brand name, serial number (if applicable), and delivery service's package identification number associated with recipient's package(s)
• The delivery service's tracking slip must reference the recipient's package(s), delivery address, and the corresponding package identification number given by the delivery service
• Without the delivery service's tracking log that identifies each individual package with a unique identification number and delivery address, the item will be denied and any overpayment will be recouped
• When the recipient denies receipt of an item, the item will be denied and an overpayment will be recouped, unless the supplier maintains a detailed shipping invoice and the delivery service’s tracking log
• Mail order DME/supply items: The date of service on the claim must be the shipping date
• Date of service exception: if the DME item is delivered to a recipient in a hospital up to two days prior to discharge (home) and for the benefit of the recipient for the purpose of fitting or training of the recipient in its use, the supplier must bill the date of service on the claim as the date of discharge (home) and must use place of service "12" (home)

Method 4: Items delivered to an LTC facility on behalf of the recipient

• Proof of delivery must be maintained in the supplier’s records as described in Methods 1 and 2
• Suppliers must work with the LTC facility staff to implement inventory control to ensure that the:
• LTC facility received delivery and was provided with receipt of what was delivered
• Supplies were identified and retained for use only by intended recipients
• Intended recipients use the supplies
• Suppliers receive proof of delivery from the LTC facility
• Medical records in the LTC facility must document use of all supplies/items billed to MHCP. Documentation may be in the nurse’s notes or a special treatment record or form
• The date of service on the claim must be the date the DME item was received by the LTC facility if delivered by the supplier, or the shipping date if the supplier used the delivery/shipping service
• Date of service exception: if the DME item is delivered to a recipient in a LTC facility up to two days prior to discharge (home) and for the benefit of the recipient for the purpose of fitting or training of the recipient in its use, the supplier must bill the date of service on the claim as the date of discharge (home) and must use place of service "12" (home)

All services that do not have appropriate proof of delivery from the supplier will be denied, and all overpayments must be returned to DHS. Suppliers who consistently do not provide documentation to support their services will be referred to the DHS Surveillance and Integrity Review Systems (SIRS) Unit and the Office of the Attorney General.

Dispensing Orders
Dispensing orders are limited orders that are written, faxed, or verbal.

For any DME/supply item to be covered by MHCP, the supplier must have an order from the prescribing provider before dispensing the item. Acting within their scope of practice, the prescribing provider may be a:

• Clinical nurse specialist
• Nurse midwife
• Nurse practitioner
• Physician
• Podiatrist
• Physician assistant

MHCP requires that providers dispense one month of supplies at a time. Providers may not ship items on a regular, monthly basis without an indication from the recipient, family member, or authorized representative that the supply is needed.

Except for items required by Medicare to have a written order prior to delivery, the "dispensing" order may be a written order (original or fax) or a verbal order. The order must contain:

• Description of item
• Name of recipient
• Name of physician
• Date of order

The supplier must maintain written documentation of the dispensing order. (This documentation must be available to DHS upon request.)

Unless required by a primary payer, no prescribing provider’s order is required for the repair of patient owned, medically necessary equipment if the supplier’s documentation includes an order for the equipment.

Detailed Written Orders
Detailed written orders contain the dispensing order and follow Medicare guidelines. Detailed written orders must be signed and dated by the treating physician before the claim is submitted to MHCP. Detailed written orders are in addition to the dispensing order, if the supplies are dispensed prior to receipt of the detailed written order. MHCP will not cover a DME/supply item if the supplier only has a verbal order when the claim is submitted.

A detailed written order must contain:

• The recipient's name and address
• A detailed description of the item
• The signature of the treating physician
• The date the order is signed (the signature and date must be personally entered by the physician and may not be a stamp or other substitute)
• If the item has been dispensed prior to the date the detailed written order is signed, the order must specify the start date
• All options or additional features which will be separately billed or which will require an upgraded code:
• The description can be either a narrative description (e.g., lightweight wheelchair base) or a brand name/model number
• Rented item orders must include the length of need
• Accessories or supplies provided on a periodic basis must include the quantity used, frequency of change or use, and length of need

The detailed description of the item may be completed by someone other than the treating provider. The treating provider must review, sign, and date the order.

A faxed order is acceptable but the supplier must be able to provide the original order to DHS upon request.

Medical Records
Medical records must contain the following information:

• The medical condition to substantiate the necessity of the type and quantity of items ordered and for the frequency of use or replacement (if applicable)
• The diagnosis and other pertinent information including duration of the condition, clinical course (worsening or improvement), prognosis, nature and extent of functional limitation, other therapeutic interventions and results, past experience with related item, etc.
• The clinical information that supports the medical necessity for the item and substantiates the information on a supplier prepared statement or physician attestation (if applicable)
• Not limited to the physician’s office records
• May include hospital, nursing home, or home health agency records
• Records from other professionals including nurses, physical or occupational therapists, prosthetists, and orthotists

DHS may request this information in selected cases. The supplier is liable for dollar amount involved if the information is not received, or does not substantiate medical necessity

Neither a physician's order, a supplier’s prepared statement, nor a physician attestation by itself provides sufficient documentation of medical necessity, even though it is signed by the treating physician.

New Order
A new order is needed when one of the following happens:

• An order changes for accessory, supply, drug, etc.
• Yearly except for items specified in coverage policy
• The item is replaced
• The supplier changes

Hospitalized Recipients

Except as noted in the Supplier documentation section, do not bill for medical equipment and supplies ordered for subsequent use in the recipient’s home prior to the date of the recipient’s discharge (home). This includes:

• Drugs, supplies used with the DME, or prosthetic devices
• Surgical dressing, urological supplies, or ostomy supplies applied in the hospital, including items worn home by the recipient

Suppliers are responsible for delivering the DME to the recipient's home following discharge.

Dispensing of Equipment/Supplies
• Dispense no more than one month of supplies at a time unless specifically permitted by coverage policy
• Requests must come from the recipient or an authorized representative each time additional supplies are needed
• It is acceptable for medical supply providers to call the recipient to verify a re-order
• Automatically shipping supplies without an indication from the recipient or the recipient’s authorized representative confirmation is not permitted

Billing Policy
• Use MN–ITS 837P Professional. Refer to the MN–ITS User Guide for DME/Med Supply/Prosthetics/Orthotics for billing instructions
• Report the name and NPI number of the actively enrolled ordering MHCP provider in the Other Provider Types section of the MN–ITS Interactive 837P claim
• Use current HCPCS procedure codes and modifiers
• To determine the appropriate HCPCS code to use with a covered service, access the Medicare Pricing, Data Analysis and Coding (PDAC) Product Classification List Web site
• Use a modifier to indicate rental, repair or replacement of part, or purchase. Additional modifiers may be appropriate depending on the item or service
• The cost of shipping, handling, or freight charges are considered all-inclusive in the MHCP payment rate and are not reimbursable. If these charges are included on the invoice or as part of the Manufacturer’s Suggested Retail Price, they will be excluded from the payment.
• Follow Medicare guidelines for when to use modifiers AU, AV, AW, KC, KE, KF, KL, KM and KN. When billing for these modifiers, providers must also include modifier NU to be reimbursed at the appropriate Medicare rate
• Do not bill for service calls that do not involve actual labor time for repairs
• Reimbursement for all rental items will cap at the Medicare purchase rate or the MHCP maximum allowed payment rate when renting any equipment. Do not continue to bill monthly rental after the maximum rate has been reached. Apply full rental payments (including all payments received from primary third party payers) to all purchases.  After MHCP purchases the medical equipment or supply for a recipient, the item is the recipient's property
• If a claim does not cross over from Medicare, and you received payment from Medicare, submit a claim to MHCP for the coinsurance/deductible. Complete the claim exactly as Medicare requires and include the recipient's MHCP ID number and your NPI number. Complete the COB tab in MN–ITS.
• For an equipment or medical supply item that requires manual pricing or is not listed on the MHCP Fee Schedule, attach the manufacturer’s invoice/price list to the claim
• Clearly indicate which item on the documentation corresponds to each item on the claim
• Do not modify, alter or change the price list or invoice
• Do not block out any information on the invoice/price list
• If the manufacturer’s invoice/price list is not available, submit a quote from the manufacturer, dated no earlier than 3 months before the date of service and no later than the date of service
• If authorization is required, the claim must match HCPCS code, modifiers and description/model number as noted on the authorization letter. Refer to the MNITS User Guide or for batch billers, the HIPAA Implementation Guide and the Minnesota Uniform Companion Guide (PDF) for field requirements.
• Although a claim may include lines with different authorization numbers, it may not include lines with and lines without authorization numbers.
• Do not bill for sales tax as durable medical equipment items are exempt from sales tax for the State of Minnesota. Refer to the Minnesota Department of Revenue’s Durable Medical Equipment Sales Tax Fact Sheet 117B (PDF) for additional information.

Legal References
MS 148.235, subd.2
MS 256B.04
, sub.14
MS 256B.071

MS 256B.0625
, subd.31
MS 256D.03
, subd.4 (5); (8)
MS 297A.67
subd. 7
Minnesota Rules 9505.0310
; 9549.0020; 9549.0040
Minnesota Rules 9505.0365
; 9505.0445
42 CFR 410.38
42 CFR 410.10 (g)(h)
42 CFR 410.36

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