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Member and Recipient Service Line: 1-877-685-2415

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12465 Results

0258 IV solutions

Service Code
0258 (Revenue) 0258 IV solutions
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0259 Other pharmacy

Service Code
0259 (Revenue) 0259 Other pharmacy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0260 General

Service Code
0260 (Revenue) 0260 General
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0261 Infusion pump

Service Code
0261 (Revenue) 0261 Infusion pump
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0262 IV therapy/pharmacy services

Service Code
0262 (Revenue) 0262 IV therapy/pharmacy services
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0263 IV therapy/drug/supply delivery

Service Code
0263 (Revenue) 0263 IV therapy/drug/supply delivery
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0264 IV therapy/supplies

Service Code
0264 (Revenue) 0264 IV therapy/supplies
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0269 Other IV therapy

Service Code
0269 (Revenue) 0269 Other IV therapy
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Home Health Services

Service Code
0270 (Revenue) Home health medical supplies
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Home Health Services include medically necessary skilled nursing services, specialized therapies (physical therapy, speech-language pathology, and occupational therapy), home health aide services, and medical supplies provided to a beneficiary in any setting in which normal life activities take place, other than a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities. Home health services may be provided in an intermediate care facility for Individuals with Intellectual Disabilities that are not required to be provided by the facility under subpart I of part 483 or any setting in which payment is or could be made under Medicaid for inpatient services that include room and board. Home health services cannot be limited to services furnished to a beneficiary who is homebound in accordance with 42 CFR 440.70.

Unit Value

1 visit

Limits

Miscellaneous supply billing without prior approval is limited to a total of $250 per beneficiary per year.

With prior approval, miscellaneous supply billing is limited to a maximum of $1500 per beneficiary per year.

  • - Incontinence supplies for children under age 3 are not covered.

Exclusions

Medicaid does not cover medical supplies that were not ordered by a physician and included on the authorized plan of care or verbal order. It does not cover routine beneficiary-care supply items such as alcohol wipes, applicators, lubricants, mouth swabs, nonsterile gloves, or thermometers. Convenience or comfort items used by persons who are not ill or injured, such as soaps, shampoos, lotions, skin conditioners, and pantiliners or pads, are not covered. Nonsterile gloves for agency staff use are considered agency overhead and are not separately billable. Items not needed in the provision of physical therapy, occupational therapy, speech-language therapy, skilled nursing, or home health aide services are not covered under the home health medical supplies benefit and instead may be considered under medical equipment policies. Attachment B also states that items such as drugs and biologicals, medical equipment, orthotics and prosthetics, and nutritional supplements are examples of items not considered home health medical supplies. General home health exclusions also apply, including duplicate services, experimental or investigational services or services that are part of a clinical trial, lack of required documentation, services when home health is not the most appropriate setting, and services related to a terminal illness when hospice has been elected unless unrelated to the terminal illness.

Place of Service

Covered only in settings where normal life activities take place; not in a hospital, nursing facility, ICF/IID except as specified, or any setting where Medicaid inpatient payment including room and board is or could be made.

Additional Service Specifics

The home health agency furnishing the service shall bill for services with its individual NPI. Providers may bill only for those services ordered by a physician and documented in the beneficiary’s individual POC.

Other Information

Home health medical supplies are billed using revenue code 270, along with the applicable HCPCS code for the individual supply.

How to Submit

N/A - No authorization is required

Resources

0271 Nonsterile supply

Service Code
0271 (Revenue) 0271 Nonsterile supply
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0272 Sterile supply

Service Code
0272 (Revenue) 0272 Sterile supply
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0273 Take-home supplies

Service Code
0273 (Revenue) 0273 Take-home supplies
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0274 Prosthetic/orthotic devices

Service Code
0274 (Revenue) 0274 Prosthetic/orthotic devices
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0275 Pacemaker

Service Code
0275 (Revenue) 0275 Pacemaker
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0276 Intraocular lens (IOL)

Service Code
0276 (Revenue) 0276 Intraocular lens (IOL)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0277 Oxygen-take-home

Service Code
0277 (Revenue) 0277 Oxygen-take-home
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

Cochlear and Auditory Brainstem Implants

Service Code
0278 (Revenue) SUPPLY/IMPLANTS
Prior Authorization Required
No
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

A cochlear implant is an electronic medical device designed to restore some ability to perceive sounds and understand speech by individuals with severe to profound hearing loss. A cochlear implant bypasses damaged hair cells in the cochlea and stimulates the remaining nerve fibers directly through the application of electrical current. Cochlear implants have external parts and internal (surgically implanted) parts that work together to allow the user to perceive sound.

An auditory brainstem implant (ABI) is a modification of the cochlear implant in which the stimulating electrode is placed directly into the brain.

After surgery, these two devices require activation, fitting of essential external components, programming, and rehabilitation for proper function and benefit.

Limits

Postoperative activation, evaluation, and programming are covered as separate procedures only for beneficiaries ages 12 years through 20 years. Contralateral cochlear implant is considered only after successful placement of the original implant and on a case-by-case basis with documentation of medical necessity.

Simultaneous bilateral cochlear implants are covered only in the limited circumstances stated in policy.

Postoperative activation, evaluation, and programming are covered after the postoperative period for beneficiaries ages 12 months and older.

Exclusions

Aural rehabilitation for physicians is billed under Clinical Coverage Policy 10A, Outpatient Specialized Therapies.Billing unit limit: procedure codes in Section C are billed with 1 unit, except CPT 92640, which is billed as 1 unit = 1 hour.

Age Group Details

Auditory Brainstem Implants- 12 through 20 years of age, Cochlear Implants/Aural Rehabilitation/Contralateral Cochlear Implant-12 months of age and older,

Place of Service

Inpatient, Outpatient.

Additional Service Specifics

Simultaneous bilateral cochlear implants are billed with 69930 and modifier 50.

How to Submit

N/A - No authorization is required

Resources

0279 Other supplies/devices

Service Code
0279 (Revenue) 0279 Other supplies/devices
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0280 General

Service Code
0280 (Revenue) 0280 General
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required

0289 Other oncology

Service Code
0289 (Revenue) 0289 Other oncology
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

How to Submit

N/A - No authorization is required