Attention Durable Medical Equipment (DME) providers Change in Billing DME Local W Codes

Durable Medical Equipment (DME) providers have been receiving denials when billing procedure code A9900 (MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS CODE) for service dates Oct. 1, 2017 and after. This issue is due to the Centers for Medicare and Medicaid Services (CMS) termination of A9900 effective Oct. 1, 2017. NC Medicaid billing guidelines required A9900 be used when billing for the following NC Medicaid local codes; W4120, W4153, W4670, W4678.

On Jan. 7, 2019, NCTracks was updated to add W4120, W4153, W4670, W4678 as options for procedure code E1399 (DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS). Providers will now find those codes in the drop-down list when billing DME claims for E1399 on the secure NCTracks provider portal. The change is effective for dates of service on or after Oct. 1, 2017. W4120, W4153, W4670, and W4678 remain as options for DME claims billed with A9900 for dates of service prior to Oct. 1, 2017.

The Job Aid PRV451, Processing DME Claims with PAs, Using Local W Codes, has been updated to reflect the billing guideline revision. The Job Aid is available in SkillPort and on the Provider User Guides and Training page of the NCTracks provider portal.