Durable Medical Equipment Items Requiring and Not Requiring Certificate of Medical Necessity (CMN) or DME Information Form (DIF)

HMSA’s policies and procedures regarding billing requirements and claims filing instructions for durable medical equipment (DME) are generally consistent with Noridian Medicare DME policies. HMSA has adopted the categories established by Medicare for items suitable for purchase and/or rental, as well as capped rental items. Precertification is not required for most DME items. Please refer to the Durable Medical Equipment, Prosthetics and Orthotics medical policy for a list of items that require precertification.

A list of Level II HCPCS codes is included in Chapter 16 - Coding of the Durable Medical Equipment Supplier Manual located on the Noridian Medicare webpage, the DME MAC for Jurisdiction D which includes Hawaii.

For commercial lines of business HMSA will accept the KX modifier and does not require a CMN or DIF for the DME listed under “KX Modifier Accepted” below. In addition, HMSA requires precertification or a CMN/DIF for the items listed below. For more information on DME modifiers, please see Billing for DME .

Please note that for HMSA’s Medicare-based plans, such as HMSA Akamai Advantage®, HMSA follows all Medicare claims filing rules.

HMSA Commercial Lines of Business – DME Claims Processing

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