R 418.10913 Billing for durable medical equipment and supplies.

Rule 913. (1) DME and supplies must be billed using the appropriate descriptor from the HCPCS Level II codebook, as referenced in R 418.10107, for the service. If the equipment or supply is billed using an unlisted or not otherwise specified code and the charge exceeds $35.00, then the acquisition cost must be included with the bill. (2) Initial claims for rental or purchased DME must be filed with a prescription for medical necessity, including the expected time span the equipment is required. (3) Durable medical equipment may be billed as a rental or a purchase. If possible, the provider and carrier shall agree before dispensing the item as to whether it should be a rental or a purchased item. With the exception of oxygen equipment, rented DME is considered purchased equipment once the monthly rental allowance exceeds the purchase price or payment of 12 months rental, whichever comes first. (4) If the worker's medical condition changes or does not improve as expected, then the rental may be discontinued in favor of purchase. (5) If death occurs, rental fees for equipment terminates at the end of the month and additional rental payments must not be made. (6) The return of rented equipment is the dual responsibility of the worker and the DME supplier. The carrier is not responsible and shall not be required to reimburse for additional rental periods solely because of a delay in equipment returns. (7) Oxygen equipment must be considered a rental as long as the equipment is medically necessary. The equipment rental allowance includes reimbursement for the oxygen contents. (8) A bill for an expendable medical supply must include the brand name and the quantity dispensed. (9) A bill for a miscellaneous supply, for example, a wig, shoes, or shoe modification, must be submitted on an invoice if the supplier is not listed as a healthcare professional.