OAR 410-130-0700: HCPCS Supplies and DME

(1) Use appropriate HCPCS codes to bill all supplies and DME. (2) For items that do not have specific HCPCS codes: (a) Use unlisted HCPCS code; (b) Bill at acquisition cost, purchase price plus postage. (3) CPT code 99070 is no longer billable for supplies and materials. Use HCPCS codes. (4) Use S3620 with modifier TC for lost newborn screening (NBS) kits. (5) The Division of Medical Assistance Programs (Division) bundles reimbursement for office surgical suites and office equipment in the reimbursement of surgical procedures. (6) Contraceptive Supplies — Refer to OAR 410-130-0585. (7) A4000–A9999: (a) Certain codes in this range are bundled or otherwise not eligible for separate payment under the division’s Fee-for-Service Medical-Surgical program. HCPCS supplies and DME that are eligible for billing under A4000-A9999 codes, must be billed in accordance with the criteria set forth in OAR 410-130-0220; (b) Do not use A4570, A4580 and A4590 for splint and cast materials. Use codes Q4001–Q4051; (c) A9150-A9999 (administrative, investigational, and miscellaneous) are not covered, except for A9500-A9699. Refer to OAR 410-130-0680. (8) B4000–B9999: (a) HCPCS codes B4034–B4036 and B4150–B9999 are not covered for medical-surgical providers; (b) Refer these services to home enteral/parenteral providers. (9) C1000–C9999 are not covered. (10) E0100–E1799: Division covers only the following DME HCPCS codes for medical-surgical providers when provided in an office setting: (a) E0100–E0116; (b) E0602; (c) E0191; (d) E1399; (e) Refer all other items with "E" series HCPCS codes to DME providers. (11) J0000–J9999 HCPCS codes — Refer to OAR 410-130-0180 for coverage of drugs. (12) K0000–K9999 HCPCS codes — Refer all items with "K" series to DME providers. (13) L0000–L9999: (a) Refer to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies program Administrative rules for coverage criteria for orthotics and prosthetics; (b) Certain “L” codes are bundled or otherwise do not pay separately. L codes must be billed in accordance with the criteria set forth in OAR 410-130-0220; (c) Reimbursement for orthotics is a global package, which includes: (A) Measurements; (B) Moldings; (C) Orthotic items; (D) Adjustments; (E) Fittings; (F) Casting and impression materials. (d) Evaluation and Management codes are covered only for the diagnostic visit where the medical appropriateness for the orthotic is determined and for follow-up visits unrelated to the fitting of the orthotic.