33.2 Benefits, Limitations, and Authorization RequirementsThe CSHCN Services Program may reimburse the rental or purchase of medically necessary and appropriate respiratory equipment. The item must be prescribed by a licensed physician and be a benefit of the CSHCN Services Program. Equipment may be rented or purchased depending on the cost-effectiveness of the action requested. In general, equipment is purchased if it is needed for more than 6 months. The CSHCN Services Program purchases only new, unused equipment. The reimbursement of rented equipment includes all supplies, accessories, adjustments, repairs, and replacement parts needed during the rental period. Exception: Oxygen concentrators and cough stimulating devices are rented, not purchased, because of high maintenance costs and the frequency of required repairs. Repairs are considered if the item was purchased by the CSHCN Services Program or is an item on the CSHCN Services Program-approved list that was obtained from another source. The repair must be more cost-effective than the cost of replacement. Repairs may be reimbursed at the list price of parts plus labor time. Providers must use procedure code E1340 when requesting authorization and submitting claims for repairs. The CSHCN Services Program considers requests for coverage of the following types of respiratory equipment: Rental or purchase of:
•
•
•
•
•
•
•
•
•
•
• Rental of:
•
• Note: Stands, carts, regulators, oxygen conservers, and carrying cases are included in the rental reimbursement for stationary gaseous oxygen cylinders, liquid oxygen systems, and portable gaseous oxygen systems.
•
• Purchase of:
•
•
•
•
•
• Note: Rental of substitute equipment is not covered when a purchased item that is under warranty is being repaired. The CSHCN Services Program will cover only one of the following per client:
•
• The CSHCN Services Program will consider the following two situations with documentation of medical necessity:
•
• The CSHCN Services Program may cover items under the Family Support Services (FSS) benefit within annual coverage limits. Type of items include, but are not limited to:
•
•
•
•
•
• Contact the CSHCN Services Program at 1-800-252-8023 for additional information about the FSS benefit. The following equipment are not a benefit of the CSHCN Services Program:
•
•
•
• Providers must have the client or the client's representative complete the CSHCN Services Program Documentation of Receipt form when DME is delivered to the client. An example of this form is provided in Appendix B, "CSHCN Services Program Documentation of Receipt" or the Appendix B, "CSHCN Services Program Documentation of Receipt (Spanish)". The date of delivery on the CSHCN Services Program Documentation of Receipt form is the date of service that should appear on the claim. The provider should retain this form; do not submit it with the claim. The following table is a list of respiratory equipment and supplies and their limitations.
|
Suction equipment
