DME Fee Schedule Update
Date: 07/03/18
Heritage Health (Medicaid):
UPDATE: DME Fee Schedule
DATE: July 3, 2018
WHAT: Nebraska Total Care established a proprietary fee schedule, effective July 1, 2018, for codes listed on the state DME fee schedule as rate not established. Upon receipt of new feedback from providers and subsequent review by Nebraska Total Care, we will be making adjustments to the below code-modifier combinations.
CHANGE: Rates for the codes in the below table will be enhanced and made retro effective to July 1, 2018. Additionally, not listed below, code-modifier combinations that are now obsolete or are not available for purchase/rental on the Medicaid fee schedule will be removed from Nebraska Total Care's proprietary fee schedule.
| Code | Modifier | Description | New Rate |
|---|---|---|---|
| A4928 | NU | SURGICAL MASK PER 20 | $0.19 |
| A6540 | NU | GRADIENT COMPRESSION STOCKING WAIST LENGTH 30-40 MMHG EACH | Invoice plus 15% |
| A6545 | NU | GRAD COMP NON-ELASTIC BK | Invoice plus 15% |
| B4088 | NU | GASTRO/JEJUNO TUBE, LOW-PRO | $103.50 |
| E0118 | NU | CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH | $70.00 |
| E0240 | NU | BATH/SHOWER CHAIR, WITH OR WITHOUT WHEELS, ANY SIZE | Invoice plus 15% |
| E0247 | NU | TRANSFER BENCH FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING | Invoice plus 10% |
| E0248 | NU | TRANSFER BENCH, HEAVY DUTY, FOR TUB OR TOILET WITH OR WITHOUT COMMODE OPENING | Invoice plus 10% |
| E0570 | LL | NEBULIZER WITH COMPRESSOR | Invoice plus 10% |
| E0720 | LL | TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, TWO LEAD, LOCALIZED | Invoice plus 10% |
| E0637 | NU | COMBINATION SIT TO STAND SYS | Invoice plus 10% |
| E1229 | NU | WHEELCHAIR PEDIATRIC SIZE NOS | Invoice plus 10% |
| E1229 | RR | WHEELCHAIR PEDIATRIC SIZE NOS | Invoice plus 15% |
| T5001 | NU | POSITIONING SEAT FOR PERSONS W/ SPCL ORTHOPEDIC NEEDS/IN VEHICLES | Invoice plus 15% |
If you have further questions, please contact your assigned Provider Relations Representative at any time.
For providers impacted, Nebraska Total Care will send out a new contract amendment in the mail that captures the updated rates in the table above.