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Supply Form for Diabetic Supplies - DOC

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									Durable Medical Equipment and Medical Supplies
Contents
                                                                   PART 2 – MEDI-CAL BILLING AND POLICY
                                                                            FOR ALLIED HEALTH SERVICES



The Contents is a list of sections contained in the Part 2 manual, Allied Health for Durable
Medical Equipment and Medical Supplies. Section titles appear in alphabetical order. The
“locator key” is an abbreviated form of the section title at the top of each page for skimming and
identifying sections. For detailed topic entries within Part 1 and Part 2, refer to the Manual
Index in the Indexes and Glossary manual.


Section Title                                                                                                Locator Key

A

Appeal Form Completion ................................................................................... appeal form

C

California Children’s Services (CCS) Program ....................................................... cal child
California Children’s Services (CCS) Program Approved Hospitals ................ cal child appr
California Children’s Services (CCS) Program Billing ......................................... cal child bil
  CCS Program Billing Guidelines
California Children’s Services (CCS) Program Billing Example:
  CMS-500 ................................................................................................... cal child bil cms
California Children’s Services (CCS) Program County Office Directory........ cal child county
California Children’s Services (CCS) Program Eligibility................................... cal child elig
California Children’s Services (CCS) Program Medical Therapy Program ...... cal child med
California Children’s Services (CCS) Program Provider Paneling .................. cal child panel
  Individual Provider Paneling Application for Physicians and Podiatrists
  Individual Provider Paneling Application for Allied Health Care Professionals
California Children’s Services (CCS) Program Referrals ....................................cal child ref

                                                                                                                (continued)




2 – Contents for Durable Medical Equipment and                 i                  Allied Health – DME and Medical Supplies 379
Medical Supplies Billing and Policy                                                                                 May 2007
Section Title                                                                                                  Locator Key

C

California Children’s Services (CCS) Program Service Authorization
  Request (SAR) ............................................................................................... cal child sar
    New Referral CCS/GHPP Client Service Authorization Request (SAR)
    Established CCS/GHPP Client Service Authorization Request (SAR)
    CCS/GHPP Discharge Planning Service Authorization Request (SAR)
California Children’s Services (CCS) Program Service Code Groupings ........... cal child ser
California Children’s Services (CCS) Program Special Care Centers ............. cal child spec
California Code of Regulations (CCR), Title 22, Section 51003,
  Prior Authorization ................................................... access on Internet at http://ccr.oal.ca.gov
California Code of Regulations (CCR), Title 22, Section 51485,
  Submission of False Information ............................. access on Internet at http://ccr.oal.ca.gov
California Code of Regulations (CCR), Title 22, Section 51520,
  Medical Supplies ..................................................... access on Internet at http://ccr.oal.ca.gov
CIF Completion ........................................................................................................... cif co
CIF Special Billing Instructions ................................................................................... cif sp
CIF Submission and Timeliness Instructions ............................................................ cif sub
CMS-1500 Completion......................................................................................... cms comp
CMS-1500 Special Billing Instructions .................................................................. cms spec
CMS-1500 Submission and Timeliness Instructions ...............................................cms sub
CMS-1500 Tips for Billing ....................................................................................... cms tips
Correct Coding Initiative: National ...........................................................................correct
Correct Coding Initiative: National – Claim Preparation ..................................... correct cod




2 – Contents for Durable Medical Equipment and                 ii                  Allied Health – DME and Medical Supplies 430
Medical Supplies Billing and Policy                                                                                   July 2011
Section Title                                                                                              Locator Key

D

Durable Medical Equipment (DME): An Overview ...................................................... dura
  Certificate of Medical Necessity for All Durable Medical Equipment (DME)
  Certificate of Medical Necessity for Apnea Monitors
  Certificate of Medical Necessity for Nebulizers
  Certificate of Medical Necessity for Oxygen
Durable Medical Equipment (DME): Bill for DME ............................................. dura bil dme
Durable Medical Equipment (DME): Bill for Infusion Equipment ......................... dura bil inf
Durable Medical Equipment (DME): Bill for Oxygen
  and Respiratory Equipment ............................................................................ dura bil oxy
Durable Medical Equipment (DME): Bill for Therapeutic
  Anti-Decubitus Mattresses and Bed Products ................................................. dura bil thp
Durable Medical Equipment (DME): Bill for Wheelchairs
  and Wheelchair Accessories ....................................................................... dura bil wheel
    Certificate of Medical Necessity for a Manual Wheelchair, Standard or Custom
    Certificate of Medical Necessity for a Motorized Wheelchair, Custom or Standard
    Certificate of Medical Necessity for a Power Operated Vehicle (POV) aka
       Scooter, Standard or Bariatric
Durable Medical Equipment (DME):
  Billing Codes and Reimbursement Rates ............................................................. dura cd
Durable Medical Equipment (DME): Billing Codes
  for California Children’s Services (CCS) ........................................................ dura cd ccs
Durable Medical Equipment (DME) Billing Codes:
  Frequency Limits ............................................................................................. dura cd fre
Durable Medical Equipment (DME): Billing Examples ............................................ dura ex




2 – Contents for Durable Medical Equipment and              iii                 Allied Health – DME and Medical Supplies 402
Medical Supplies Billing and Policy                                                                              March 2009
Section Title                                                                                             Locator Key

E

Enteral Nutrition: List of Available Products .............................................................enteral

F

Forms: Legibility and Completion Standards ....................................................... forms leg
Forms Reorder Request: Guidelines ................................................................... forms reo
Forms Reorder Request: Medical Services and Allied Health ........................ forms reo ma

G

Genetically Handicapped Persons Program (GHPP) ............................................... genetic

H

HCPCS Introduction................................................................................................... hcpcs
HCPCS Level III Interim Code List: Reimbursable Medi-Cal-Only Codes ............. hcpcs iii

I

Incontinence Medical Supplies: An Overview ........................................................... incont
Incontinence Medical Supplies: Contractor/Manufacturer List ............................ incont con
Incontinence Medical Supplies Example: CMS-1500 ........................................... incont ex
Incontinence Products: Belted Undergarments ............................................ incont prod belt
Incontinence Products: Briefs, Disposable ................................................. incont prod brief
Incontinence Products: Creams and Washes ................................................. incont prod cr
Incontinence Products: Protective Underwear, Disposable ..................... incont prod protect
Incontinence Products: Reusable Underwear ............................................. incont prod reus
Incontinence Products: Shields, Liners and Pads, Disposable ................. incont prod shield
Incontinence Products: Underpads, Disposable .......................................... incont prod und
Incontinence Supplies Prescription Form: Completion.................................. incont sup com
   Incontinence Supplies Prescription Form
Intravenous or Intra-arterial Solutions: Administration Sets .............................. iv sol admin




2 – Contents for Durable Medical Equipment and             iv                  Allied Health – DME and Medical Supplies 402
Medical Supplies Billing and Policy                                                                             March 2009
Section Title                                                                                         Locator Key

M

Medical Supplies: An Overview............................................................................... mc sup
Medical Supplies: Billing Examples..................................................................... mc sup ex
Medical Supplies: Medicare Covered Services .............................................. mc supp medi
Medical Supply Products: Diabetic Supplies ............................................... mc sup prod dia
Medical Supply Products: Miscellaneous .................................................. mc sup prod misc
Medical Supply Products: Ostomy – Accessories ................................... mc sup prod ost ac
Medical Supply Products: Ostomy – One-Piece
 Closed/Urinary Pouches/Skin Barriers .......................................... mc sup prod ost oneclos
Medical Supply Products: Ostomy –
 One-Piece Drainable Pouches ......................................................... mc sup prod ost onedr
Medical Supply Products: Ostomy Two-Piece
 Drainable/Closed Pouches ............................................................... mc sup prod ost twodr
Medical Supply Products: Ostomy Two-Piece Extended
 Wear Skin Barriers ........................................................................... mc sup prod ost twoex
Medical Supply Products: Ostomy Two-Piece
 High Output/Urinary Pouches ............................................................ mc sup prod ost twohi
Medical Supply Products: Ostomy Two-Piece
 Standard Wear Skin Barriers ........................................................... mc sup prod ost twostd
Medical Supply Products: Tracheostomy –
 A thru F Manufacturers ........................................................................ mc sup prod trach a
Medical Supply Products: Tracheostomy –
 G thru M Manufacturers ...................................................................... mc sup prod trach g
Medical Supply Products: Tracheostomy –
 N thru S Manufacturers ....................................................................... mc sup prod trach n
Medical Supply Products: Tracheostomy –
 T thru Z Manufacturers ......................................................................... mc sup prod trach t




2 – Contents for Durable Medical Equipment and           v                 Allied Health – DME and Medical Supplies 430
Medical Supplies Billing and Policy                                                                           July 2011
Section Title                                                                                           Locator Key

M

Medical Supply Products: Urologicals – Drainage Bags ...................... mc sup prod uro drain
Medical Supply Products: Urologicals – External Catheters .................. mc sup prod uro ext
Medical Supply Products: Urologicals – Indwelling Catheters ............... mc sup prod uro ind
Medical Supply Products: Urologicals – Insertion Trays ..................... mc sup prod uro insert
Medical Supply Products: Urologicals – Intermittent
 Catheters – Manufacturers A thru F ................................................... mc sup prod uro int a
Medical Supply Products: Urologicals – Intermittent
 Catheters – Manufacturers G thru M .................................................. mc sup prod uro int g
Medical Supply Products: Urologicals – Intermittent
 Catheters – Manufacturers N thru Z ................................................... mc sup prod uro int n
Medical Supply Products: Urologicals –
 Tubes, Clamps and Connectors ........................................................ mc sup prod uro tube
Medical Supply Products: Wound Care –
 Advanced Contracted ................................................................... mc sup prod wou adv con
Medical Supply Products: Wound Care –
 Advanced Non-Contracted ...........................................................mc sup prod wou adv non
Medical Supply Products: Wound Care – Bandages,
 Gauzes, Packing Strips, Eye Pads .................................................. mc sup prod wou band
Medicare/Medi-Cal Crossover Claims: CMS-1500............................................medi cr cms
Medicare/Medi-Cal Crossover Claims:
 CMS-1500 Billing Examples for Allied Health ........................................... medi cr cms exa
Medicare/Medi-Cal Crossover Claims:
 Medi-Cal Pricing Examples for Allied Health ............................................ medi cr cms pra
Medicare/Medi-Cal Crossover Claims: UB-04 .................................................... medi cr ub
Medicare/Medi-Cal Crossover Claims: UB-04 Billing Examples ..................... medi cr ub ex
Medicare Non-Covered Services: Charts Introduction .................................... medi non cha
Medicare Non-Covered Services: HCPCS Codes .......................................... medi non hcp
Modifiers: Approved List ......................................................................................modif app




2 – Contents for Durable Medical Equipment and            vi                 Allied Health – DME and Medical Supplies 422
Medical Supplies Billing and Policy                                                                      November 2010
Section Title                                                                                                 Locator Key

O

Optional Benefits Exclusion ............................................................................... opt ben exc
Orthotic and Prosthetic Appliances: Billing Codes and
 Reimbursement Rates – Orthotics ..................................................................... ortho cd1
Orthotic and Prosthetic Appliances: Billing Codes and
 Reimbursement Rates – Prosthetics.................................................................. ortho cd2
Orthotics and Prosthetics: Frequency Limits for Orthotics ...................................... ortho cd fre1
Orthotics and Prosthetics: Frequency Limits for Prosthetics.................................. ortho cd fre2
Other Health Coverage (OHC) ................................................................................. oth hlth

P

Provider Billing after Beneficiary Reimbursement (Conlan v. Shewry)..................... prov bil

R

Remittance Advice Details (RAD) ......................................................................... remit adv
Remittance Advice Details (RAD) Examples:
  Allied Health and Medical Services ................................................................ remit ex am
Remittance Advice Details (RAD): Payments and Claim Status .......................... remit pay
Respiratory Care ........................................................................................................ respir
Resubmission Turnaround Document (RTD) Completion .................................. resub comp




2 – Contents for Durable Medical Equipment and               vii                  Allied Health – DME and Medical Supplies 415
Medical Supplies Billing and Policy                                                                                 April 2010
Section Title                                                                                              Locator Key

S

Share of Cost (SOC): CMS-1500 ........................................................................ share cms
Sign Language Interpretation ....................................................................................... sign
Speech Generating Devices (SGD) ........................................................................ spe dev

T

TAR Completion..................................................................................................... tar comp
TAR Criteria for NF Authorization (Valdivia v. Coye) ............................................. tar crit nf
TAR Deferral/Denial Policy (Frank v. Kizer) ............................................................tar defer
TAR Discharge Planning Option ............................................................................... tar dis
TAR Discharge Planning Option Codes ............................................................... tar dis cod
TAR Field Office Addresses ..................................................................................... tar field
TAR Submission: Transmittal Form .................................................................... tar submis
TAR: Submitting Appeals .....................................................................................tar submit
Taxable and Non-Taxable Items .................................................................................... tax




2 – Contents for Durable Medical Equipment and             viii                 Allied Health – DME and Medical Supplies 404
Medical Supplies Billing and Policy                                                                               May 2009

								
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