Miscellaneous durable medical equipment billing guidelines
Reminder: Miscellaneous durable medical equipment (DME) procedure codes (such as E1399) cannot be used as an alternative to specific identified codes. Empire BlueCross BlueShield HealthPlus (Empire) will conduct postpayment reviews to ensure the right codes for the right services are used. This applies to all claims for Medicaid Managed Care members.
In an effort to improve the provider experience, we continually evaluate coding and billing patterns. Recently, we identified trends related to the use of E1399 — DME, miscellaneous. This code is only intended for use when a more appropriate code is not available. When an appropriate code does exist, that code must be used regardless of your contracted rate. It is not appropriate to use E1399 for payment increases.
We continue to require prior authorization for the use of miscellaneous code E1399. To request PA, you may use one of the following methods:
- Web: https://www.availity.com
- Fax: 1-800-964-3627
- Phone: 1-800-450-8753
As it is not our policy to inform providers of proper billing processes within prior authorization responses, authorization responses do not include code-specific details. If your service was approved but your claim was denied payment when billed using E1399, the incorrect code was used. You will need to update the authorization and the claim with the appropriate HIPAA-compliant HCPCS code.
Empire will conduct postpayment reviews of code E1399 to ensure proper use. If it is determined a more appropriate code should have been used, we will notify you in writing and advise you of your appeal rights.
You can find additional information related to miscellaneous codes in the Unlisted, Unspecified or Miscellaneous Codes reimbursement policy at www.empireblue.com/nymedicaiddoc > Precertification & Claims > Medicaid Reimbursement Policies.
June 2018 Empire Provider Newsletter