Prior Authorization
Some DMEPOS services/items require prior authorization. Requests maybe submitted through the Online Prior Authorization System (OPAS) or by fax using form FH-1 (use form FH-1A for continuing usage of BIPAP and CPAP devices).
It is critical to submit complete and accurate clinical documentation on prior authorization requests. Documentation must include the prescription and fully support medical necessity of the item. When submitting supporting medical documentation online, the name and credentials of the provider who supplied the information are required. Failure to provide this information may result in a denied request and/or may delay the determination.
MSM Chapter 1300, including Appendix B lists specific prior authorization and documentation
requirements. If you have any questions, please contact the Prior Authorization Department at (800)
525-2395.
All items dispensed to recipients in an institutional setting (e.g., Nursing Facility (NF) or Intermediate Care Facility for the Mentally Retarded (ICF/MR)), require prior authorization for exception to inclusive facility rates.
Durable medical equipment (DME ) medical billing. How to do billing for Medicare and what equipment covered by Medicare. DME Modifiers and CPT codes.
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