Durable Medical Equipment (DME) and Oxygen Supplies

Effective April 3, 2020, throughout the duration of the COVID-19 state of emergency in Colorado, Health First Colorado is waiving prior authorization requirements for oxygen therapy, positive airway pressure devices, respiratory assist devices, ventilators, suction devices, nebulizers and oxygen related supplies that are emergently provided for COVID-19 treatment. This applies to any diagnosed person with COVID-19 or suspected person under investigation for COVID-19.

For these services to be reimbursed without Prior Authorization, providers must include the ‘CR’ modifier to designate that the requested item or service is related to treating a member who is diagnosed/suspected with COVID-19.

To support this policy, the Colorado interChange system will be configured to bypass prior authorization edits for DME codes outlined below when the claim type is Professional (M) or Professional Medicare Crossover (B), the billing provider contract is Supply, and modifier CR is submitted on the claim. HCPCS allowed under this policy are shown in the tables below. Note: some codes listed do not require Prior Authorization.

Contact the Provider Call Center for more information. 

Billing Guidance

DME Category Associated HCPCS
Positive Airway Pressure Device Humidifiers A7046 E0562 E0561              
Oxygen Delivery System Humidifiers E1405 E1406                
IPPB Device Humidifiers E0500 E0550 E0555 E0560            
Oxygen Storage Contents E0441 E0442 E0443 E0444 S8120 S8121        
Oxygen Storage Systems E0424 E0425 E0430 E0431 E0433 E0434 E0434 E0439 E0440 K0738
Oxygen Concentrators E1390 E1391 E1392              
Respiratory Assist Devices and Related Supplies E0470 E0471 E0472              
Ventilators and Related Supplies E0457 E0459 E0465 E0466 A4483 S8186 A4611 A4612 A4613 S8210
Cough Stimulating Devices/Mucus Removal and Related Supplies A7020 A7025 E0482 E0483 E0606 S8185 E0480 A7026    
Positive Airway Pressure Devices and Related Supplies A4604 A7027 A7028 A7029 A7030 A7031 A7033 A7032 A7034 A7035
A7036 A7038 A7039 A7044 A7045 E0601 A7037      
Suction Devices A7000 A7001 A7002 E0600            
Nebulizers and Related Supplies A7003 A7004 A7005 A7006 A7007 A7008 A7009 A7010 A7012 A7013
A7014 A7015 A7016 A7017 A7018 E0565 E0570 E0572 E0574 E0575
E0580 E0585 E1372 K0730 A4617 S8100 S8101      
Tracheostomy Supplies E0755 S8189 A4608 A4618 A4623 A4624 A4625 A4629 A7501 A7502
A7503 A7504 A7505 A7506 A7507 A7508 A7509 A7520 A7521 A7522
A7523 A7524 A7525 A7526 A7527 A4481 L8501 A4605    
Generally Related Supplies A9280 A4606 S8301 A4615 A4616 A4619 A4620 A4627 A4628 E0455
E1353 E1354 E1355 E1356 E1357 E1358 A4614 S8999    

 

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