Update to the Durable Medical Equipment and Supplies Provider Manual, Chapter IV

Memo

January 4, 2024, 9:51AM

To:

All Durable Medical Equipment and Supplies providers participating in the Virginia Medical Assistance Program, Managed Care Organizations, and holders of the Durable Medical Equipment and Supplies Provider Manual

From:

Cheryl Roberts, Director Department of Medical Assistance Services (DMAS)

The purpose of this memorandum is to highlight changes and additions the Department of Medical Assistance Services (DMAS) made to Chapter IV of the Durable Medical Equipment (DME) and Supplies Manual. DME and supplies are a covered service available to the entire Medicaid population including both Fee for Service and Managed Care enrollees. Coverage criteria for Complex Rehabilitation Technology for members living in a nursing facility were added to the manual and are effective 1/1/2024. Changes were also made to update Face to Face HCPCS code list, Cardinal Care, Enteral Nutrition, Respiratory sections of the manual.

If providers are unsure of the appropriate code to use for a particular item, one resource is the DME classification site, which is designed to assist providers with DME coding. Providers can search by different criteria and by brand name. The website can be accessed at https://www.dmepdac.com/dmecsapp/do/search.

Please note: Appendix B of the Durable Medical Equipment (DME) and Supplies Provider Manual has been updated and is now available on the DMAS website (https://www.dmas.virginia.gov/for-providers/long-term-care/services/durable-medical-equipment/). All competitive bid rates are highlighted in blue.

PROVIDER CONTACT INFORMATION & RESOURCES

Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

https://vamedicaid.dmas.virginia.gov/

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996

Acentra Health

Service authorization information for fee-for-service members.

https://dmas.kepro.com/

Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

https://www.dmas.virginia.gov/appeals/

Managed Care Programs

Cardinal Care Managed Care and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Cardinal Care Managed Care

https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-…

PACE

http://www.dmas.virginia.gov/#/longtermprograms

Acentra Health

Behavioral Health Services

https://dmas.kepro.com/

Provider Enrollment

In-State: 804-270-5105

Out of State Toll Free: 888-829-5373

Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com

Provider HELPLINE