01/21/2021

DME Denials (L3000, L1902, L4360, E0760)-Workers Compensation

We recently have received denials when billing NYS Workers Compensation for DME items (i.e. L3000, L1902, L4360, E0760) stating "durable medical equipment fee schedule does not apply to medical providers supplying DME to injured workers as part of medical treatment described in the official NY Workers Compensation medical fee schedule. We are sending the invoice with the claim. Should we not be billing with the "L" codes and use 99070 instead? Thank you

Reviewing the EOB from the WC carrier, the HCPCS code for each of the DME items should not be billed. Each item given to the patient should be billed under CPT 99070. To make sure that each line item is reimbursed appropriately:

-Each line item should have a description to describe the item dispensed

-Each charge should be equal to the purchase cost with no markup 

-The invoice should be included to justify the DME purchase costs to the practice