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DME/OXY Services for COVID-19 Testing and Treatment Per All Provider Bulletin 292

June 8, 2020

Durable Medical Equipment (DME) providers, Oxygen and Respiratory Therapy Equipment (OXY) providers, and Pharmacy providers with a DME and/or OXY specialty are advised that on May 2, 2020, MassHealth issued All Provider Bulletin 292 (https://www.mass.gov/files/documents/2020/05/02/ALL-292.pdf) that provides guidance for COVID-19 testing and COVID-19 related treatment provided to individuals who are uninsured or supported through Health Safety Net (HSN) and individuals supported through the MassHealth Limited benefit. For uninsured individuals and those supported through HSN, please see All Provider Bulletin 292.

Individuals who are supported through the MassHealth Limited benefit:

Per All Provider Bulletin 292, MassHealth DME and OXY providers may seek reimbursement for COVID-19 related treatment provided to MassHealth Limited members. (Please note: COVID-19 related treatment is considered "emergency services" as defined in 130 CMR 450.105(f)).

  • DME and OXY services provided to MassHealth Limited members with a diagnosis of COVID-19 must be related to the COVID-19 diagnosis in order for MassHealth to reimburse for these services under All Provider Bulletin 292.
  • DME and OXY services provided but unrelated to a diagnosis of COVID-19, are not reimbursable by MassHealth. Inappropriate billing may be subject to sanctions.
  • Providers must seek prior authorization for any codes identified as subject to prior authorization in the MassHealth Durable Medical Equipment and Oxygen Payment and Coverage Guideline Tool. The link for the tool is: https://tinyurl.com/y94rnus7.

Billing Guidelines: DME and OXY providers should follow the standard MassHealth billing procedures for DME and OXY, and include the following claim information:

  • Enter Diagnosis as "COVID diagnosis, emergency diagnosis".
  • Enter the emergency indicator (837P).
  • Note that claims that qualify for payment will initially deny, however such claims will be automatically reprocessed within a two-week period. Providers do not need to resubmit these claims.

If you have any questions, please contact the LTSS Service Center at (844) 368-5184 or support@masshealthltss.com.