Medicaid (TMHP) Reimbursement Reductions

Effective for dates of service on or after September 1, 2011, various percentage reductions were applied to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) procedure codes.   The percentage reductions were published in the Medicaid Online Fee Lookup (OFL), and in the Medicaid static fee schedule titled NEW DMEPOS. 

Eyewear percentage reduction total is 8%. 

CLICK HERE FOR THE OFL

Note:  Durable Medical Equipment (DME) items are reimbursed the lesser of the provider’s billed charges or the published amounts.  If the amount billed is less than the amount in the Access-Based or Max Fee amount, the percentage reduction will be applied to the provider’s billed charges.  For a claim to process correctly, providers MUST bill their usual and customary rate for the item and not an adjusted rate.