MHCP pays for repairs to medically necessary recipient-owned durable medical equipment and prosthetics/orthotics. MHCP pays for maintenance service agreements for some recipient-owned equipment that requires frequent servicing or calibration.
The following providers may repair recipient-owned equipment and prosthetics or orthotics:
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer.
MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or deductible is requested.
Cost effective repairs to recipient-owned medically necessary durable medical equipment and prosthetics or orthotics are covered for eligible MHCP recipients.
K0462: Temporary replacement for patient-owned equipment being repaired, any type
K0739: Repair or non-routine service for DME other than oxygen, labor component, per 15 minutes
K0740: Repair or non-routine service of oxygen equipment, labor component, per 15 minutes
The following codes are eligible for maintenance service contracts if the equipment is recipient-owned and meets criteria: B9000. B9002. B9004, B9006, E0445, E0450, E0460, E0461, E0463, E0464. E0470, E0471, E0482, E0483, E0600, E0609, E0617, E0779, E0781, E1390, E01392, E1399, K0606, K0730
Authorization is required sometimes.
If providers do not have appropriate loaner equipment for the recipient to use while equipment is being repaired, rental equipment may be provided. MHCP will reimburse providers for one month’s rental. To bill, use K0462 and include the HCPCS code of the item being repaired in the “comments” section of the claim.
If the rental is longer than one month, providers must submit a request for authorization. Explain the unusual circumstances and rental time needed.
Equipment should not be repaired if the cost to repair exceeds the cost to replace, or if the repair will not significantly extend the usable life of the equipment.
Maintenance service contracts are available for patient-owned equipment that is necessary to sustain life, and that requires regular, professional attention beyond the capability of most recipients. Examples of the types of equipment that may require a maintenance service contract are patient-owned oximeters, ventilators, respiratory assist devices and defibrillators.
When MHCP pays for a maintenance service contract, the provider becomes responsible for all regularly scheduled service to keep equipment functioning correctly for six months. If repairs are needed, the repairs may be provided in addition to the maintenance service contract.
See Mobility Devices section for information on repairs to wheelchairs or power operated vehicles.
Equipment that always requires authorization for purchase always requires authorization for repair or modification.
Equipment that sometimes requires authorization for purchase, and equipment that never requires authorization for purchase, will require authorization for repair or modification if parts combined with labor charges total $400 or more.
Maintenance service agreements for E1399 always require authorization.
When requesting authorization for a maintenance service agreement for a recipient-owned equipment item without a specific HCPCS code, use modifier MS and include the date the equipment was purchased or converted to sale, and document the manufacturer’s maintenance requirements.. One unit equals a six-month service agreement.
If MHCP did not authorize or purchase the equipment being repaired/maintained, include documentation that the equipment meets current medical necessity criteria.
If the equipment is nearing the end of its expected usable life (usually five years), document how long the repair is expected to extend the lifespan of the equipment.
MHCP will not authorize repairs where the cost to repair exceeds the cost to replace or where the repair is not expected to significantly extend the life of the equipment. Requests for repairs where the cost to repair exceeds 90% of the cost to replace must include documentation to show that the repair is a less costly alternative over time than replacement with a new item under warranty.
Submit authorization requests and required documentation to the authorization medical review agent.