DentalWriter Forum

Your central resource for DentalWriter posts, blogs, training resources, faq's, and more.

Notification

Icon
Error

5 Pages<12345>
Post Reply
courtneydsnow
#41 Posted : Wednesday, April 19, 2017 6:49:24 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi JIN KIM DMD!

No problem. The diagnosis pointer (field 24E) is going to be the letter that the diagnosis code that applies to the line item appears in that is entered in field 21. For example, if there is only one diagnosis code, the diagnosis pointer with simply be "A". If there are two and they both apply to the service, the diagnosis pointer will be "AB", if three, it will be "ABC".

For field 24I, that is generally left blank.

For field 24B (place of service), if you are billing Medicare DME for an oral appliance for OSA, the place of service will be 12, which stands for home. If you are billing a private insurer or Medicare part B for other services like office visits, x-rays, etc, the place of service will be 11, which stands for office.

Here is a link to the full CMS1500 claim form manual, which gives additional details on each section of the claim form:
http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v4.pdf

Our software DentalWriter help you complete medical claims for dental practices and does most of this for you. If you'd like to see a demo of it, here is a link where you can schedule in a demo:
https://niermanpm.com/demo

Hope this helps!

Edited by user Wednesday, April 19, 2017 6:50:06 AM(UTC)  | Reason: Not specified

Amanda
#42 Posted : Wednesday, May 10, 2017 12:44:19 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
One of my patients has medicare and a secondary insurance. She does not want a medicare approved appliance, but another non-approved appliance. What documentation do I need to submit to medicare to receive a denial so that I can submit to secondary insurance?
courtneydsnow
#43 Posted : Thursday, May 11, 2017 8:33:58 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi Amanda!

Per the policy article to the Medicare LCD for oral appliances for OSA, if the sleep appliance used is not PDAC cleared for E0486, it must be coded using A9270, which stands for: Non-covered item or service, here is the language below the references this:

"All custom fabricated mandibular advancement devices that have not received a written PDAC Verification Review must use HCPCS code A9270 (NON-COVERED ITEM OR SERVICE)"

Hope this helps, have a great day!

Guest
#44 Posted : Sunday, July 23, 2017 1:34:35 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
I have a question in regards to DME billing for E0486.

Are office visits/follow-up visits included if the device is being given by a sleep lab/physician. Is there a global period for these devices where follow-up in included.
courtneydsnow
#45 Posted : Monday, July 24, 2017 8:19:31 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi guest!

Yes most medical insurers include 90 days of follow up care included in E0486, including Medicare.

For Medicare DME specifically, a sleep lab/physician should not be delivering custom made oral appliances for OSA, as the Medicare LCD for oral appliances for OSA specifies that only a DDS/DMD should be the one to deliver & bill for E0486 in the coverage criteria.

Hope this helps!
Guest
#46 Posted : Thursday, August 10, 2017 3:18:18 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
Where can we go to obtain reimbursement rates for various states for HCPCS E0486
courtneydsnow
#47 Posted : Friday, August 11, 2017 7:33:01 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi guest!

The allowed amounts for E0486 are actually not currently published on the Medicare DME fee schedule. However, if you would like to tell me what state you're interested in, I can let you know what we see coming back on EOB's as the current allowed amount for Medicare.
Guest
#48 Posted : Wednesday, August 16, 2017 12:55:28 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
What is the reimbursement rate for Tennessee - specifically Nashville, 37220.
courtneydsnow
#49 Posted : Thursday, August 17, 2017 9:20:57 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi guest!

The allowed amount for E0486 for Medicare DME for Tennessee is approx. $1144.87

Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!
Guest
#50 Posted : Tuesday, August 22, 2017 10:41:31 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
Hi,

Would you happen to know the expected Medicare DME allowed amount for E0486 in Florida (Jurisdiction C)?
courtneydsnow
#51 Posted : Tuesday, August 22, 2017 1:13:49 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi Guest!

The approximate allowed amount for E0486 for Medicare DME Florida is $1051.04

Hope this helps!
Guest
#52 Posted : Tuesday, August 29, 2017 3:43:43 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
What is Medicare reimbursement for Mississippi?
Thanks!
courtneydsnow
#53 Posted : Thursday, August 31, 2017 9:46:14 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi Guest!

The allowed amount for Medicare DME for E0486 is approx. $1051.04

Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!
hm
#54 Posted : Friday, September 29, 2017 4:25:00 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
Hi, What is the reimb for Montana? Also, do I need to use any other modifiers other than NU (such as a modifier for the ABN?) I have an approval.

thanks!
courtneydsnow
#55 Posted : Monday, October 2, 2017 8:39:24 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi hm!

Medicare's allowed amount for E0486 for Montana is approximately $1311.05. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

As far as modifiers, yes you will certainly use the "NU" modifier. Then, either KX, GA or GZ, depending on the situation.

KX tells Medicare you have all of the required documentation on file
GA means Waiver of Liability statement on file. Use this modifier to report that an ABN was issued for a service and ABN is on file
GZ means is used to report an item or service expected to be denied as not reasonable and necessary.

The Medicare LCD for oral appliances for OSA states:

"If all of the coverage criteria have not been met, the GA or GZ modifier must be added to a claim line for the oral appliance. When there is an expectation of a medical necessity denial, suppliers must enter the GA modifier on the claim line if they have obtained a properly executed Advance Beneficiary Notice (ABN) or the GZ modifier if they have not obtained a valid ABN. Claim lines billed without a GA, GZ, or KX modifier will be rejected as missing information."

Hope this helps!
Guest
#56 Posted : Tuesday, October 3, 2017 12:12:26 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
Does anyone know the medicare reimbursement for Illinois?
courtneydsnow
#57 Posted : Wednesday, October 4, 2017 9:14:00 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi Guest!

Medicare's allowed amount for E0486 for Illinois is approximately $1281.36. Medicare covers 80% of that, and either the patient or the secondary if they have one will cover the other 20%.

Hope this helps!
Cindy
#58 Posted : Tuesday, October 10, 2017 10:49:18 AM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
I work for a ENT provider who wants to partner with a dentist office in providing these oral appliances. After reading several articles I am confused as to what my provider would bill. He provided me with the E0486 code but my reading shows that that is to be billed by the Dentist. I am new to DME. I have never billed it before. To do this correctly could you explain the proper billing for my ENT provider and the Dentist also.

Thanks.
courtneydsnow
#59 Posted : Wednesday, October 11, 2017 7:47:19 AM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,611

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi Cindy!

Feel free to send me an e-mail and we can set up some time to chat. courtney@dentalwriter.com
Guest
#60 Posted : Monday, January 8, 2018 3:12:44 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 2,185

Was thanked: 16 time(s) in 15 post(s)
Does anyone know the medicare reimbursement for California?
Quick Reply Show Quick Reply
5 Pages<12345>
Post Reply
Forum Jump  
You cannot post new topics in this forum.
You can reply to topics in this forum.
You can delete your posts in this forum.
You can edit your posts in this forum.
You cannot create polls in this forum.
You can vote in polls in this forum.