AmeriHealth has updated its policy on durable medical equipment (DME) and consumable medical supplies, as supported by the AmeriHealth benefit contracts. Claim Payment Policy #05.00.21s: Durable Medical Equipment (DME) and Consumable Medical Supplies is currently posted as a Notification and will go into effect May 22, 2018.
Policy changes
Below is a summary of the policy changes.
Additions
- HCPCS codes E0953, E0954, and E0574 have been added to Attachment A1, which details items that are considered DME and may be eligible based on applicable medical policies and benefit requirements.
- The following HCPCS codes have been added to Attachment B as items that not do not meet the definition of DME, and are, therefore, not covered:
- – A4244
- – A4246
- – A4247
- – A4248
- – A4360
- – A4520
- – A4553
| - – A4554
- – A4674
- – A4927
- – A4928
- – A4930
- – A4931
- – A6000
| - – A6250
- – A9273
- – E0188
- – E0189
- – T4521
- – T4522
- – T4523
| - – T4524
- – T4525
- – T4526
- – T4527
- – T4528
- – T4529
- – T4530
| - – T4531
- – T4532
- – T4533
- – T4534
- – T4335
- – T4536
- – T4537
| - – T4338
- – T4539
- – T4540
- – T4541
- – T4542
- – T4543
- – T4544
|
Deletions
- HCPCS codes E0188 and E0189 have been removed from Attachment A1 and added to Attachment B, as not covered items.
- HCPCS codes K0070 and S1040 have been removed from this policy. Please refer to applicable medical policies for coverage and eligibility requirements.
- HCPCS codes E0574 and L8510 have been removed from Attachment B of this policy and may be eligible based on medical policy and benefit requirements. Please refer to applicable medical policies for coverage and eligibility requirements.
More information
To view the Notification for this policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial under Active Notifications.