This BadgerCare Plus Update lists disposable medical supplies (DMS) covered under the BadgerCare Plus Benchmark Plan for dates of service on and after June 1, 2008, and revises copayment policy for DMS under the Benchmark Plan. The Update also clarifies policy regarding hearing aid batteries, which are not covered under the Benchmark Plan.
Effective for dates of service (DOS) on and after June 1, 2008, the coverage for disposable medical supplies (DMS) under the BadgerCare Plus Benchmark Plan will reflect the information in this BadgerCare Plus Update. The Benchmark Plan has added new Healthcare Common Procedure Coding System (HCPCS) procedure codes to the list of covered DMS. Hearing aid batteries are not covered under the Benchmark Plan. There are no copayments for DMS covered under the Benchmark Plan.
Changes to HCPCS Procedure Codes Covered Under the Benchmark Plan
The Attachment of this Update provides a complete and updated list of DMS covered under the Benchmark Plan. Providers should be aware that the DMS Index, available at dhs.wisconsin.gov/medicaid4/maxfees/maxfee.htm, lists current maximum allowable fees and monthly limitations for DMS but does not reflect current Benchmark Plan coverage of DMS items that are included in this Update.
The following HCPCS procedure codes have been added to the list of covered DMS under the Benchmark Plan, effective for DOS on and after June 1, 2008:
- A4250 (Urine test or reagent strips or tablets [100 tablets or strips]).
- A4258 (Spring-powered device for lancet, each).
- A4258 with modifier “22” (Insulin pen).
- A4624 (Tracheal suction catheter, any type other than closed system, each).
- A7027 (Combination oral/nasal mask, used with continuous positive airway pressure device, each).
- A7028 (Oral cushion for combination oral/nasal mask, replacement only, each).
- A7029 (Nasal pillows for combination oral/nasal mask, replacement only, pair).
- S8490 (Insulin syringes [100 syringes, any size]).
The following HCPCS procedure codes are considered noncovered DMS under the Benchmark Plan for DOS on and after June 1, 2008:
- A4206 (Syringe with needle; sterile 1cc or less, each).
- A4207 (Syringe with needle; sterile 2cc, each).
- A4208 (Syringe with needle; sterile 3cc, each).
- A4209 (Syringe with needle; sterile 5cc or greater, each).
- A4213 (Syringe, sterile, 20cc or greater, each)
- A4213 with modifier “59” (Syringe, 50/60 cc).
Beginning on June 1, 2008, providers may bill Benchmark Plan members for the noncovered services listed above.
Policy Correction Regarding Hearing Aid Batteries Under the Benchmark Plan
Hearing aid batteries, HCPCS code V5266 (battery for use in hearing device), are not covered under the Benchmark Plan. This policy was effective with the February 1, 2008, implementation of BadgerCare Plus.
Copayments Under the Benchmark Plan
The Benchmark Plan does not charge copayments for covered DMS.
Information Regarding BadgerCare Plus HMOs
BadgerCare Plus HMOs are required to provide at least the same benefits as those provided under fee-for-service arrangements. For managed care policy, contact the appropriate managed care organization.
Attachment — Disposable Medical Supplies Covered Under the BadgerCare Plus Benchmark Plan
