Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Part 2 – Durable Medical Equipment and Medical Supplies (DME)

106,894 Bytes206,336 Bytes

Medi-Cal Program (00medi-cal)

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Medi-Cal Provider Manual Contents

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Manual Organization (0Amanorg)

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How to Use This Manual (0Bhwtouse)

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Getting Started: Where to Find the Answers (0C get start)

13,802 Bytes48,640 Bytes

Contents (Part 2 – Medi-Cal Billing and Policy): Durable Medical Equipment and Medical Supplies (DME) (2toc dme)

111,825 Bytes163,840 Bytes

Appeal Form Completion (appeal form)

15,702 Bytes52,736 Bytes

California Children's Services (CCS) Program (cal child)

5,600 Bytes32,768 Bytes

California Children’s Services (CCS) Program Approved Hospitals (cal child appr)

9,823 Bytes32,256 Bytes

California Children's Services (CCS) Program Billing (cal child bil)

458,832 Bytes524,800 Bytes

California Children's Services (CCS) Program Billing Example: CMS-1500 (cal child bil cms)

9,952 Bytes40,448 Bytes

CCS Program Billing Guidelines (cal child bil guide)

20,850 Bytes112,128 Bytes

California Children’s Services (CCS) Program County Office Directory (cal child county)

10,560 Bytes49,664 Bytes

California Children's Services (CCS) Program Eligibility (cal child elig)

9,495 Bytes34,304 Bytes

California Children's Services (CCS) Program Medical Therapy Program (cal child med)

36,132 Bytes67,072 Bytes

California Children's Services (CCS) Program Provider Paneling (cal child panel)

16,759 Bytes90,624 Bytes

Form: California Children’s Services (CCS) Program Individual Provider Paneling Application for Physicians and Podiatrists (DHS 4514)

20,274 Bytes102,912 Bytes

Form: California Children’s Services (CCS) Program Individual Provider Paneling Application for Allied Health Care Professionals (DHS 4515 )

12,914 Bytes72,704 Bytes

California Children's Services (CCS) Program Referrals (cal child ref)

27,850 Bytes101,376 Bytes

California Children's Services (CCS) Program Service Authorization Request (SAR) (cal child sar)

67,694 Bytes300,032 Bytes

California Children’s Services (CCS) Program Service Code Groupings (cal child ser)

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California Children’s Services (CCS) Program Special Care Centers (cal child spec)

125,559 Bytes209,408 Bytes

CIF Completion (cif co)

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CIF Special Billing Instructions (cif sp)

64,864 Bytes100,864 Bytes

CIF Submission and Timeliness Instructions (cif sub)

565,731 Bytes722,432 Bytes

CMS-1500 Completion (cms comp)

196,368 Bytes261,632 Bytes

CMS-1500 Special Billing Instructions (cms spec)

17,983 Bytes77,824 Bytes

CMS-1500 Submission and Timeliness Instructions (cms sub)

13,571 Bytes51,712 Bytes

CMS-1500 Tips for Billing (cms tips)

17,679 Bytes70,144 Bytes

Correct Coding Initiative: National (correct)

132,668 Bytes173,568 Bytes

Correct Coding Initiative: National – Claim Preparation (correct cod)

31,280 Bytes108,032 Bytes

Durable Medical Equipment (DME): An Overview (dura)

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Form: Certificate of Medical Necessity for All Durable Medical Equipment (DME) (Except Wheelchairs and Scooters) (DHS 6181)

7,333 Bytes40,448 Bytes

Form: Certificate of Medical Necessity for Apnea Monitors (MC 4600)

7,182 Bytes41,472 Bytes

Form: Certificate of Medical Necessity for Nebulizers (MC 4601)

12,058 Bytes52,736 Bytes

Form: Certificate of Medical Necessity for Oxygen (MC 4602)

58,745 Bytes240,640 Bytes

Durable Medical Equipment (DME): Bill for DME (dura bil dme)

16,369 Bytes57,344 Bytes

Durable Medical Equipment (DME): Bill for Infusion Equipment (dura bil inf)

50,336 Bytes228,352 Bytes

Durable Medical Equipment (DME): Bill for Oxygen and Respiratory Equipment (dura bil oxy)

53,807 Bytes269,824 Bytes

Durable Medical Equipment (DME): Bill for Therapeutic Anti-Decubitus Mattresses and Bed Products (dura bil thp)

26,977 Bytes110,080 Bytes

Durable Medical Equipment (DME): Bill for Wheelchairs and Wheelchair Accessories (dura bil wheel)

274,925 Bytes352,256 Bytes

Form: Certificate of Medical Necessity for a Manual Wheelchair, Standard or Custom (DHS 6181-A)

282,134 Bytes359,424 Bytes

Form: Certificate of Medical Necessity for a Motorized Wheelchair, Custom or Standard (DHS 6181-B)

249,872 Bytes330,240 Bytes

Form: Certificate of Medical Necessity for a Power Operated Vehicle (POV) aka Scooter, Standard or Bariatric (DHS 6181-C)

87,179 Bytes736,256 Bytes

Durable Medical Equipment (DME): Billing Codes and Reimbursement Rates (dura cd)

10,071 Bytes40,448 Bytes

Durable Medical Equipment (DME): Billing Codes for California Children's Services (CCS) (dura cd ccs)

19,889 Bytes98,816 Bytes

Durable Medical Equipment (DME) Billing Codes: Frequency Limits (dura cd fre)

4,034,713 Bytes4,481,024 Bytes

Durable Medical Equipment (DME): Billing Examples (dura ex)

45,299 Bytes176,640 Bytes

Durable Medical Equipment (DME): Wheelchair and Wheelchair Accessories Guidelines (dura wheel guide)

41,140 Bytes180,736 Bytes

Enteral Nutrition Products (enteral)

13,843 Bytes43,520 Bytes

Forms: Legibility and Completion Standards (forms leg)

9,676 Bytes32,256 Bytes

Forms Reorder Request: Guidelines (forms reo)

30,633 Bytes64,512 Bytes

Forms Reorder Request: Medical Services and Allied Health (forms reo ma)

30,815 Bytes112,640 Bytes

Genetically Handicapped Persons Program (GHPP) (genetic)

14,749 Bytes51,200 Bytes

HCPCS Introduction (hcpcs)

10,838 Bytes57,856 Bytes

HCPCS Level III Interim Code List: Reimbursable Medi-Cal-Only Codes (hcpcs iii)

25,300 Bytes105,984 Bytes

Incontinence Medical Supplies (incont)

449,806 Bytes521,216 Bytes

Incontinence Medical Supplies Example: CMS-1500 (incont ex)

13,992 Bytes87,040 Bytes

Incontinence Supplies Prescription Form: Completion (incont sup com)

7,770 Bytes53,248 Bytes

Form: Incontinence Supplies Prescription Form

11,442 Bytes44,544 Bytes

Intravenous or Intra-arterial Solutions: Administration Sets (iv sol admin)

28,032 Bytes110,080 Bytes

Medical Supplies (mc sup)

469,992 Bytes576,000 Bytes

Medical Supplies: Billing Examples (mc sup ex)

29,584 Bytes111,104 Bytes

Medicare/Medi-Cal Crossover Claims: CMS-1500 (medi cr cms)

462,308 Bytes531,456 Bytes

Medicare/Medi-Cal Crossover Claims: CMS-1500 Billing Examples for Allied Health (medi cr cms exa)

33,816 Bytes193,536 Bytes

Medicare/Medi-Cal Crossover Claims: CMS-1500 Pricing Examples for Allied Health (medi cr cms pra)

20,181 Bytes73,216 Bytes

Medicare/Medi-Cal Crossover Claims: UB-04 (medi cr ub)

198,834 Bytes265,728 Bytes

Medicare/Medi-Cal Crossover Claims: UB-04 Billing Examples (medi cr ub ex)

4,725 Bytes29,696 Bytes

Medicare Non-Covered Services: Charts Introduction (medi non cha)

15,573 Bytes65,536 Bytes

Medicare Non-Covered Services: HCPCS Codes (medi non hcp)

39,004 Bytes254,976 Bytes

Modifiers: Approved List (modif app)

33,016 Bytes131,584 Bytes

Optional Benefits Exclusion (opt ben exc)

61,410 Bytes509,440 Bytes

Orthotic and Prosthetic Appliances: Billing Codes and Reimbursement Rates – Orthotics (ortho cd1)

45,989 Bytes371,200 Bytes

Orthotic and Prosthetic Appliances: Billing Codes and Reimbursement Rates – Prosthetics (ortho cd2)

15,734 Bytes60,416 Bytes

Orthotics and Prosthetics: Frequency Limits for Orthotics (ortho cd fre1)

13,443 Bytes52,736 Bytes

Orthotics and Prosthetics: Frequency Limits for Prosthetics (ortho cd fre2)

15,887 Bytes53,760 Bytes

Other Health Coverage (OHC) (oth hlth)

12,367 Bytes44,032 Bytes

Provider Billing after Beneficiary Reimbursement (Conlan v. Shewry) (prov bil)

11,832 Bytes40,448 Bytes

Remittance Advice Details (RAD) (remit adv)

25,207 Bytes159,744 Bytes

Remittance Advice Details (RAD) Examples: Allied Health and Medical Services (remit ex am)

10,686 Bytes35,328 Bytes

Remittance Advice Details (RAD): Payments and Claim Status (remit pay)

28,174 Bytes110,080 Bytes

Respiratory Care (respir)

690,784 Bytes803,328 Bytes

Resubmission Turnaround Document (RTD) Completion (resub comp)

626,283 Bytes734,208 Bytes

Share of Cost (SOC): CMS-1500 (share cms)

11,715 Bytes45,056 Bytes

Sign Language Interpretation (sign)

16,113 Bytes67,584 Bytes

Speech Generating Devices (SGD) (spe dev)

122,726 Bytes191,488 Bytes

TAR Completion (tar comp)

19,946 Bytes89,600 Bytes

TAR Criteria for NF Authorization (Valdivia v. Coye) (tar crit nf)

294,934 Bytes543,232 Bytes

TAR Deferral/Denial Policy (Frank v. Kizer) (tar defer)

29,359 Bytes122,368 Bytes

TAR Field Office Addresses (tar field)

104,194 Bytes151,552 Bytes

TAR Submission: Transmittal Form (tar submis)

10,532 Bytes33,792 Bytes

TAR: Submitting Appeals (tar submit)

32,300 Bytes186,880 Bytes

Taxable and Non-Taxable Items (tax)



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