Empire continually evaluates coding and billing patterns, and recently identified trends related to the use of code E1399 — DME, miscellaneous. When an appropriate code exists for DME equipment or supply, the more specific code should be used.

 

Inappropriate use of code E1399 often includes, but is not limited to the following:

  • Gait trainers (E8001/E8002)
  • Shower chairs (E0240)
  • Standing frames (E0641)
  • Hospital beds (E0250-E0373)
  • Stand assist lifts (E0635)

 

To ensure proper use of E1399, Empire conduct post-payment reviews of code E1399.  If a more appropriate code should have been used, Empire may recoup overpayments accordingly.

 

Empire continues to require prior authorization for the use of miscellaneous code E1399. If a prior authorization is approved but the claim is submitted with the incorrect code E1399, then the claim may be denied and a corrected claim will need to be resubmitted with the appropriate HCPCS code.



Featured In:
June 2018 Empire Provider Newsletter