Apple Health (Medicaid) Provider Alert
Attention Durable Medical Equipment providers:
Effective for dates of service on and after August 1, 2020, the Health Care Authority (HCA) is adding a new benefit for bed encasements.
Dust mite mattress and pillow encasements are considered medically necessary for children age 20 years and younger under the following conditions:
- Diagnosis of persistent asthma;
- Documented dust-mite sensitivity as demonstrated by skin testing, blood testing, or a clinical history strongly supportive of dust-mite sensitivity (such as consistent night-time congestion, cough, or wheeze in the absence of other explanation); and
- Other indoor environmental trigger reduction efforts are being optimized.
Billing:
- Use procedure code A9286 for bed encasements. Limit one set, per client, during a five-year period.
- Use EPA #8700016045 for mattress (twin) and EPA #870001605 for pillowcases (set of 2).
- Complete and include with the claim HCA’s Bed and Pillow Encasements form, HCA 13-0052.
- To download an HCA form, see HCA’s Forms & Publications webpage.
HCA will update the Medical Equipment & Supplies Billing Guide, dated August 1, 2020, to reflect this update.
|
