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

Universal Citation: WY Code of Rules 9-4

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.

(i) The Division has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection a of this section; and

(iii) The incorporated code, standard, rule or regulation is maintained at 5221 Yellow stone Road, Cheyenne, WY 82002 and is available for public inspection and copying at cost at the same location.

(b) Each code incorporated by reference in these rules is further identified as follows:

(i) Reference to the Non-Rural Wyoming Medicare rate of the Healthcare Common Procedure Coding System (HCPCS) is adopted by the Division and effective on January 1, of the year for the date of service submitted found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html.

(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.

(i) Any single supply/DME item/orthotic or prosthetic; not listed in the Non-Rural Medicare HCPCS fee schedule and has no Optum 360 gap fill value, charged at $1,000.00 or more, shall require a supplier's invoice. Reimbursement shall be at 130% of invoice cost. Shipping and handling charges shall not be reimbursed.

(ii) Reimbursement for HCPCS code E0676-Intermittent Limb Compression Device will be paid at a flat rate of four hundred dollars ($400) for use of this device during the surgical procedure only.

(iii) The Division shall not provide direct payment to suppliers or manufacturers for implantable items.

(e) The preceding fees are not intended to address newly developed items or technologies.

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