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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

July 2014

Update: Durable Medical Equipment Payment Policy


Harvard Pilgrim has updated its Durable Medical Equipment (DME) Payment Policy to clarify rental periods, including breaks in service, and replacement guidelines, effective for dates of service beginning October 1, 2014.

Rental Period and Breaks in Service

A new rental period for the DME will begin if there is an interruption in the medical necessity for the item that lasts for more than 61 days (more than two 30-day billing cycles). Before billing for the item, please first utilize any unused days from the prior billing cycle. (For example, if the member stopped using the DME on June 15, but Harvard Pilgrim had been billed for June 1-30, please use the remaining 15 days before starting a new billing cycle.)

If the interruption is not more than 61 days, a new rental period will not begin and the rental time will accrue as part of the prior rental period.

Replacement

Harvard Pilgrim will apply item limits and replacement periods on many items as indicated on Harvard Pilgrim’s DME fee schedules. If a replacement is needed prior to the replacement period published on the fee schedule, the replacement must be billed with the RA modifier (RA – Replacement of a DME, orthotic, or prosthetic item) on the first replacement claim in addition to the appropriate modifier (NU or RR) according to our standard payment methodology. Replacements cannot be made less than 60 days from the date of purchase or two full rental months from the completion of the rental period.

To request an updated DME fee schedule, please contact the Provider Service Center at 800-708-4414. For complete information, including information on Harvard Pilgrim’s policies for repairs to DME, please refer to the updated Durable Medical Equipment Payment Policy in Harvard Pilgrim’s Provider Manual.

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Editor

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