09/08/2017

DME Dispensing to Patients Enrolled in Medicare Advantage Plans-Empire Blue Cross (MediBlue)

I have just been told by my BCBS rep that podiatrists are not allowed to dispense DME to BCBS Medicare HMO patients. These patients must go to specific DME providers. Dr. Langone was hoping you can confirm this for us because we have been paid in the past by them. We are billing L4397. Thank you.

Reviewing all medical policies for DME products on the Empire Blue Cross website, there are no limitations on who can dispense durable medical equipment to patients enrolled in Medicare Advantage Plans. As long as the medical necessity criteria is met (which the insurance based from Medicare), it should be covered by the patient’s plan. In addition, since Empire bases their coverage criteria from the local DME carrier, there should be no restrictions for a podiatrist dispensing this type of equipment.

For both of the MediBlue HMO plans offered, the patient handbooks do not specify that they need to purchase this from an in-network DME supplier. The information related to Dr. Langone from the provider representatives has to be incorrect unless there is another document not publicly available that specifies otherwise.