Reminder: DME HCPCS payment policy is changing, effective March 1, 2018

As announced in the December 2017 Record, effective March 1, 2018, Blue Cross Blue Shield of Michigan is making changes to how we process durable medical equipment HCPCS codes for Blue Cross’ commercial PPO products. We’re adding four categories to explain how we’ll pay for DME.

Click on each category for a list of DME HCPCS codes:

The DME capped rental period is expanding from 10 monthly payments to 13 monthly payments. After 13 monthly payments, the equipment will be considered purchased.

We’re also expanding the capped rental and reasonable useful lifetime time frame.
The reasonable useful lifetime for purchased DME is expanding from every three years to five years. This aligns with Centers for Medicare & Medicaid Services policy.

These changes will result in updates to the rental fees, specifically for the capped rental HCPCS codes. These changes will be incorporated into the newly published DME/P&O Fee Schedule, effective March 1, 2018.

You can access the fee schedule via web-DENIS.

Log in to web-DENIS.
Click on BCBSM Provider Publications and Resources.
Click on Entire Fee Schedules and Fee Changes.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM. *CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.