Durable Medical Equipment (DME) is often purchased for patients and paid for by their health insurance. The amount that Medicare or Medicaid will pay is set by the reimbursement rate associated with a HCPCS (Healthcare Common Procedure Coding System) Level II Code. Private insurers may use this reimbursement rate but are not obligated to. Just as private insurers are not obligated to reimburse for DME according to Medicare and Medicaid rates, they are also not obligated to purchase DME at all. In other words, having a HCPCS Level II code is not a guarantee that your product will be purchased. However, having a HCPCS Level II code is a starting point for negotiation. The only thing worse than having an unfavorable reimbursement rate for your device is not having any code at all. That is why submitting a Coding Verification Request is critical. It puts your product into the insurance system, and you or your distributors are then free to negotiate rates with private insurance companies.

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September, 2018. All rights reserved.