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Durable Medical Equipment Reimbursement Update Effective March 1, 2022

Audience: Participating Providers

We would like to advise you of a delay in the effective date for durable medical equipment (DME) reimbursement updates, as detailed below.  We previously communicated an effective date of January 1, 2022; the revised effective date is March 1, 2022.

Beginning March 1, DME reimbursement will be in accordance with the 2021 Medicare fee schedule and methodology for the Medicare line of business and the 2021 Medicaid fee schedule and methodology for the Safety Net line of business.  Safety Net refers to Medicaid Managed Care (including the Health and Recovery Plan, or HARP), Child Health Plus, Healthy NY and Essential Plan.

You can access the fee schedules online at:

Medicare: cms.gov
Medicaid: EMedNY.org

Final determination of coverage is subject to the member’s benefits and eligibility on the date of service. Before rendering services, please confirm member eligibility and authorization requirements at Provider.ExcellusBCBS.com. If you do not currently have secure web access, click on the Login/Register button and select “Register & Create an Account” to get started. Eligibility for Medicaid Managed Care, including HARP members, should also be verified at EMedNY.org.

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Reimbursement

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