Mileage Reimbursement (FYI)
Craig R. DeCamp
Description
Collection
Title:
Mileage Reimbursement (FYI)
Creator:
Craig R. DeCamp
Date:
8/28/2009
Text:
This link will take you to the bulletin with the following excerpt:
<URL Redacted>
Travel Charges Associated with Repairing DMEPOS Items
National Government Services has received questions regarding reimbursement for travel cost associated with in home repairs for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items. On December 23, 2008, the Centers for Medicare & Medicaid Services (CMS) released revisions to the labor payment rates associated with repairing DMEPOS items in Change Request 6297. The revised labor payment rates apply to Healthcare Common Procedure Coding System (HCPCS) codes E1340, L4205 and L7520. In this Change Request, CMS advises that under the previous updates to labor payment rates, annual inflation adjustments were not applied consistently from state to state. This was due to rates being established based on historic supplier charges, which may or may not have included annual inflation adjustments. The new rates established for codes E1340, L4205, and L7520 are based upon 25 percent of the previous hourly rate for codes E1350, L4200, and L7500 respectively.
As indicated above, the previous labor payment rates were based upon the supplier’s historic charges. Travel costs are assumed to have been taken into account by suppliers in setting the prices they charged for these services under these codes. Therefore, because the cost for travel time has already been accounted for in the calculation of the rates for codes E1340, L4205, and L7520, separate payment shall not be made for travel cost associated with repairing DMEPOS items.
If a supplier chooses to bill separately, code A9901 (DME delivery, set‐up, and/or dispensing service component of another HCPCS code) must be used. This code will auto deny as a contractual obligation (CO) denial. Suppliers may not bill Medicare beneficiaries directly for travel charges.
Change Request 6297 contains specific instructions regarding the revisions to the labor payment rates associated with repairing DMEPOS items. Suppliers may review Change Request 6297 in its entirety at www.cms.hhs.gov/transmittals/downloads/R421OTN.pdf.
The payment calculation for labor payment rates associated with repairing DMEPOS items is not new to the Medicare Fee schedule. Suppliers may also reference TriCenturion’s October 2007, DME program safeguard contractor (PSC) bulletin article titled “FAQ Repair and Replacement.” This article provides additional clarification as to what cost are included in the reimbursement for labor. To view this article please visit the National Government Services Web site at www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ToolsandMaterials/pdf/Repairandreplacement.pdf.
Craig R. DeCamp
Board Certified Orthotist & Prosthetist
2041 Klondike Road
West Lafayette, IN 47906
(765)418-9619 Cell
(765)463-4100 Office
(765)463-4112 Fax
(888)508-LIMB (5462)
<mailto:<Email Address Redacted>> <Email Address Redacted>
<URL Redacted>
Travel Charges Associated with Repairing DMEPOS Items
National Government Services has received questions regarding reimbursement for travel cost associated with in home repairs for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items. On December 23, 2008, the Centers for Medicare & Medicaid Services (CMS) released revisions to the labor payment rates associated with repairing DMEPOS items in Change Request 6297. The revised labor payment rates apply to Healthcare Common Procedure Coding System (HCPCS) codes E1340, L4205 and L7520. In this Change Request, CMS advises that under the previous updates to labor payment rates, annual inflation adjustments were not applied consistently from state to state. This was due to rates being established based on historic supplier charges, which may or may not have included annual inflation adjustments. The new rates established for codes E1340, L4205, and L7520 are based upon 25 percent of the previous hourly rate for codes E1350, L4200, and L7500 respectively.
As indicated above, the previous labor payment rates were based upon the supplier’s historic charges. Travel costs are assumed to have been taken into account by suppliers in setting the prices they charged for these services under these codes. Therefore, because the cost for travel time has already been accounted for in the calculation of the rates for codes E1340, L4205, and L7520, separate payment shall not be made for travel cost associated with repairing DMEPOS items.
If a supplier chooses to bill separately, code A9901 (DME delivery, set‐up, and/or dispensing service component of another HCPCS code) must be used. This code will auto deny as a contractual obligation (CO) denial. Suppliers may not bill Medicare beneficiaries directly for travel charges.
Change Request 6297 contains specific instructions regarding the revisions to the labor payment rates associated with repairing DMEPOS items. Suppliers may review Change Request 6297 in its entirety at www.cms.hhs.gov/transmittals/downloads/R421OTN.pdf.
The payment calculation for labor payment rates associated with repairing DMEPOS items is not new to the Medicare Fee schedule. Suppliers may also reference TriCenturion’s October 2007, DME program safeguard contractor (PSC) bulletin article titled “FAQ Repair and Replacement.” This article provides additional clarification as to what cost are included in the reimbursement for labor. To view this article please visit the National Government Services Web site at www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ToolsandMaterials/pdf/Repairandreplacement.pdf.
Craig R. DeCamp
Board Certified Orthotist & Prosthetist
2041 Klondike Road
West Lafayette, IN 47906
(765)418-9619 Cell
(765)463-4100 Office
(765)463-4112 Fax
(888)508-LIMB (5462)
<mailto:<Email Address Redacted>> <Email Address Redacted>
Citation
Craig R. DeCamp, “Mileage Reimbursement (FYI),” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/230649.
