Reimbursement Rates for Some DME Services Procedure Codes to Change for the CSHCN Services Program Effective September 1, 2011

Transcription

1 s for Some DME s Procedure Codes to Change for the CSHCN s Program Effective September 1, 2011 Information posted July 15, 2011 Effective for dates of services on or after September 1, 2011, the reimbursement rates for the some durable medical equipment (DME) services procedure codes will change for the Children with Special Health Care Needs (CSHCN) s Program. In the table that begins on the following page, rate increases are presented in green, and rate decreases are presented in red. The age ranges that are indicated for the rates in the tables reflect the rate for a child (birth through 20 years of age), an adult (21 years of age or older), or a client of any age. The age ranges may not reflect a specific age limitation that has been established that may limit services to a specific client age. To obtain specific age limitations for individual procedure codes, providers can refer to the current CSHCN s Program Provider Manual, Current Procedural Terminology (CPT) coding manual, or Healthcare Common Procedure Coding System (HCPCS) coding manual. Note: The rates in the table do not include any current or future rate reductions that may be applicable. For more information, call the TMHP-CSHCN s Program Contact Center at

2 J E0135 Manually priced TG Manually Priced L E0140 $ $36.07 $4.00 L E0144 $ $ $1.75 L E0147 $ $52.02 $15.04 J E0156 $ $ $0.01 J E0163 Manually priced TG Manually Priced J E0165 Manually priced TG Manually Priced L E0175 $ $5.21 -$1.01 J E0182 $ $ $38.30 J E0190 $ $50.00 $15.56 J E0194 $31, $31, $31.10 L E0196 $ $34.11 $3.12 L E0197 $ $18.83 $0.83 L E0200 $ $ $0.01 J E0205 $ $ $0.20 L E0205 $ $ $0.02 L E0217 $ $ $5.37 L E0218 Manually priced Manually Priced J E0218 $ $ $ L E0231 Manually priced Manually Priced L E0232 Manually priced Manually Priced J E0236 $ $ $20.90 J E0240 Manually priced Manually Priced J E0247 $ $96.41 $31.69 J E0248 $ $ $40.99 J E0249 $ $ $0.10 L E0249 $ $ $0.01 J E0251 $ $ $0.70 J E0256 $ $ $0.80 J E0261 $1, $1, $1.20 J E0266 $1, $1, $1.60 J E0271 $ $ $36.18 J E0272 $ $ $0.17 J E0280 $ $ $3.63 L E0280 $ $3.72 -$0.39 J E0290 $ $ $0.70 J E0291 $ $ $0.50 J E0292 $ $ $0.80 J E0293 $ $ $27.60 J E0294 $1, $1, $1.20 J E0295 $1, $1, $1.20 J E0296 $1, $1, $1.50 J E0297 $1, $1, $1.30 J E0304 Manually priced Manually Priced J E0305 $ $ $1.33 L E0310 $ $ $6.34 J E0315 Manually priced Manually Priced J E0316 Manually priced $1, J E0328 $4, $5, $ L E0328 $ $ $90.20 L E0424 $ $ $2.62 L E0431 $ $ $3.02 L E0434 $ $ $3.02 L E0439 $ $ $2.62 L E0441 $ $38.50 $5.07 L E0443 $ $38.50 $5.07 L E0444 $ $38.50 $10.87 J E0445 $ $ $29.50

3 L E0445 $ $ $2.95 L E044F $ $ $25.00 L E0459 $ $45.42 $15.19 J E0470 $1, $3, $1, L E0480 $ $39.03 $1.33 L E0483 $1, $1, $ L E0550 $ $46.46 $1.36 J E0561 $ $ $10.16 L E0561 $ $9.67 -$1.02 J E0562 $ $ $27.13 L E0562 $ $ $1.47 J E0565 $1, $ $ L E0565 $ $ $18.02 J E0570 $ $ $16.88 J E0574 $ $ $20.10 J E0575 $ $1, $ J E0580 $ $ $12.73 L E0580 $ $ $1.27 J E0601 $ $1, $ L E0619 $ $ $22.38 J E0625 Manually priced Manually Priced L E0625 Manually priced $40.92 L E0630 $ $ $10.35 J E0635 $1, $2, $ J E0637 $3, $3, $ J E0638 $1, UA $2, $ J E0638 $2, UB $2, $ J E0641 $2, $2, $ J E0642 Manually priced $3, L E0650 $ $ $10.10 L E0652 $ $ $22.74 L E0655 $ $8.65 -$2.66 L E0660 $ $ $3.93 L E0665 $ $ $3.26 L E0666 $ $ $3.85 L E0668 $ $43.41 $3.83 J E0669 Manually priced $ L E0669 Manually priced $16.61 J E0676 $ Manually Priced L E0676 $ Manually Priced J E0748 $3, $3, $ J E0779 $ $ $8.40 L E0781 $ $ $9.07 J E0784 $4, $4, $4.22 L E0784 $ $ $22.93 J E0855 Manually priced $ L E0855 Manually priced $47.16 L E0920 $ $48.45 $9.22 L E0930 $ $47.97 $10.15 L E0936 $ $ $26.80 L E0940 $ $31.17 $2.77 L E0946 $ $38.04 $0.13 J E0992 $ $ $12.58 J E1009 Manually priced Manually Priced J E1011 Manually priced Manually Priced J E1018 Manually priced Manually Priced J E1029 $ $ $35.11 L E1050 $ $ $10.17

4 L E1060 $ $ $12.28 L E1070 $ $91.53 $2.83 L E1083 $ $ $2.44 L E1084 $ $83.77 $2.59 L E1085 $ $65.38 $6.71 L E1086 $ $78.67 $7.82 L E1087 $ $ $10.91 L E1088 $ $ $14.46 L E1089 $ $ $14.53 L E1090 $ $ $9.96 L E1092 $ $ $13.81 L E1093 $ $ $10.04 L E1100 $ $ $13.00 L E1130 $ $45.61 $4.14 L E1140 $ $63.61 $3.32 L E1150 $ $75.37 $3.76 L E1160 $ $55.36 $1.99 J E1161 $2, $2, $ L E1161 $ $ $24.91 L E1170 $ $93.78 $9.69 L E1171 $ $84.16 $4.40 L E1172 $ $84.73 $3.67 L E1180 $ $ $14.95 L E1190 $ $ $20.96 L E1195 $ $ $16.56 L E1200 $ $ $1.59 J E1220 Manually priced Manually Priced J E1221 $ $ $0.50 L E1221 $ $ $0.05 J E1222 $ $ $0.70 L E1222 $ $ $0.07 J E1223 $ $ $0.80 L E1223 $ $ $0.08 J E1224 $ $ $0.90 L E1224 $ $ $0.09 J E1225 $ $ $0.40 L E1225 $ $ $0.04 J E1226 $ $ $0.48 L E1226 $ $ $0.05 J E1227 $ $ $0.24 L E1227 $ $ $0.03 J E1228 $ $ $0.30 L E1228 $ $ $0.03 J E1229 Manually priced Manually Priced L E1230 $ $ $20.28 J E1231 $4, $3, $1, L E1231 $ $ $55.72 J E1232 $4, $2, $2, L E1232 $ $ $0.01 J E1233 $2, $2, $ L E1233 $ $ $30.68 J E1234 $2, $2, $ L E1234 $ $ $4.34 L E1237 $ $ $34.06 L E1238 $ $ $37.85 J E1239 Manually priced Manually Priced L E1240 $ $97.98 $10.50 L E1250 $ $72.93 $11.62

5 L E1260 $ $90.09 $9.52 J E1270 $ $ $ L E1270 $ $82.89 $16.54 J E1280 $1, $1, $ L E1280 $ $ $28.88 L E1285 $ $ $27.27 L E1290 $ $ $6.06 L E1295 $ $ $12.51 J E1353 $ $ $13.84 L E1390 $ $ $2.62 J E1399 $ Manually Priced L E1399 $ Manually Priced L E1510 $ $1, $ J E1520 $1, $ $1, L E1520 $ $ $98.85 J E1530 $ $ $18.38 L E1530 $ $ $7.28 L E1540 Manually priced Manually Priced J E1540 $ $22.96 $12.57 J E1550 $ $ $22.46 L E1550 $ $ $2.27 J E1560 Manually priced Manually Priced L E1560 Manually priced Manually Priced J E1570 $ $ $ L E1570 $ $ $14.70 L E1575 Manually priced $0.16 J E1575 $ $1.63 $0.36 J E1580 Manually priced Manually Priced L E1580 Manually priced Manually Priced J E1590 Manually priced Manually Priced J E1592 Manually priced Manually Priced L E1592 Manually priced Manually Priced J E1594 $5, $6, $1, L E1594 $ $ $ L E1600 Manually priced $ J E1620 $1, $1, $ L E1620 $ $ $52.42 J E1630 Manually priced Manually Priced L E1630 Manually priced Manually Priced J E1632 Manually priced Manually Priced L E1632 Manually priced Manually Priced J E1635 Manually priced Manually Priced L E1636 Manually priced $1, J E1637 $ $5.33 $2.83 J E1699 Manually priced Manually Priced L E1699 Manually priced Manually Priced L E1800 $ $ $ L E1802 $ $ $16.34 L E1805 $ $ $ L E1810 Manually priced $ L E1812 $ $ $4.30 L E1815 Manually priced $ L E1825 Manually priced $ L E1830 Manually priced $ J E1840 $3, $4, $ L E2100 $ $ $23.41 J E2205 Manually priced Manually Priced J E2206 Manually priced Manually Priced

6 J E2291 Manually priced Manually Priced J E2292 Manually priced Manually Priced J E2293 Manually priced Manually Priced J E2294 Manually priced Manually Priced L E2402 $1, $1, $ J E2506 $2, $2, $0.02 J E2512 Manually priced Manually Priced J E2599 Manually priced Manually Priced L E2599 Manually priced Manually Priced J E2602 Manually priced Manually Priced J E2603 Manually priced Manually Priced J E2604 Manually priced Manually Priced J E2605 Manually priced Manually Priced J E2606 Manually priced Manually Priced J E2607 Manually priced Manually Priced J E2608 Manually priced Manually Priced J E2609 Manually priced Manually Priced J E2611 Manually priced Manually Priced J E2612 Manually priced Manually Priced J E2613 Manually priced Manually Priced J E2614 Manually priced Manually Priced J E2615 Manually priced Manually Priced J E2616 Manually priced Manually Priced J E2617 Manually priced Manually Priced J E2619 Manually priced Manually Priced J E2620 Manually priced Manually Priced J E8001 Manually priced Manually Priced L E8001 Manually priced Manually Priced J E0435 $ $ $ J E0440 $1, $1, $26.20 J E0462 $3, $3, $3.10 L E0462 $ $ $0.31 J E0482 $4, $2, $1, J E0500 $1, $1, $ J E0572 $ $ $0.40 L E0572 $ $ $0.04 L E0585 $ $ $1.75 L E0606 $ $ $3.94 L E0618 $ $ $11.91 L E0637 $ $ $ J E0749 $2, $2, $ E0765 $ $88.40 $0.06 L E0945 $ $2.66 -$1.30 J E0956 $ $ $0.09 J E0959 $ $ $0.05 J E0966 $ $ $0.07 J E0967 $ $ $0.07 L E0978 $ $3.63 -$0.13 J E0985 $ $ $0.21 L E0990 $ $13.94 $3.77 J E1030 $1, $1, $1.05 J E1031 $ $ $0.50 J E1036 $10, $9, $1, E1083 $ $ $ TOS: J = DME Purchase New L = DME Rental