We continually evaluate coding and billing patterns, and recently identified trends related to the use of code E1399 — DME, miscellaneous. When an appropriate code exists for DME equipment or supply, the more specific code should be used.

 

Inappropriate use of code E1399 often includes, but is not limited to the following:

 

  • Gait trainers (E8001/E8002)
  • Shower chairs (E0240)
  • Standing frames (E0641)
  • Hospital beds (E0250-E0373)
  • Stand assist lifts (E0635)

 

To help ensure proper use of E1399, we conduct post-payment reviews of code E1399.  If a more appropriate code should have been used, we may recoup overpayments accordingly.

 

We continue to require prior authorization for the use of miscellaneous code E1399. If a prior authorization is approved but the claim is submitted with the incorrect code E1399, the claim may be denied and a corrected claim will need to be resubmitted with the appropriate HCPCS code.



Featured In:
June 2018 New Hampshire newsletter