Wyoming Administrative Code
Agency 053 - Workforce Services, Department of
Sub-Agency 0021 - Workers' Compensation Division
Chapter 9 - FEE SCHEDULES
Section 9-4 - Fees for Supplies, Implants, Durable Medical Equipment (DME), Orthotics and Prosthetics
Current through September 21, 2024
(a) The Division adopts the Non-Rural Wyoming Medicare rate plus thirty percent (+30%) of the Healthcare Common Procedure Coding System (HCPCS) as the rates were published as of January 1, of the year for the date of service submitted, for the payment of supplies, DME, orthotics and prosthetic devices prescribed by a health care provider. See Chapter 9, Section 1 for additional guidelines. The Division shall not pay for any supplies, DME, orthotics, or prosthetics unless prescribed by the treating health care provider. The Division will not include quarterly updates for these payments, the payments will remain consistent with the January 1, of the year for the date of service submitted published rates.
(b) Each code incorporated by reference in these rules is further identified as follows:
(c) Please refer to CMS Medicare Learning Network (MLN) document at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/DMEPOSQuality/DMEPOSQualBooklet-905709.html for the required documentation to be submitted with each supply, DME, orthotic, or prosthetic order. Prior authorization is only completed for items over two thousand five-hundred dollars ($2,500) and is voluntary.
(d) Any related charges for supplies, DME, orthotics and prosthetics not listed in the Non-Rural Wyoming Medicare HCPCS fee schedule shall be paid using the Optum 360 gap fill values or at eighty percent (80%) of billed charges; whichever is less. Charges deemed excessive shall require additional documentation for justification.
(e) The preceding fees are not intended to address newly developed items or technologies.