In an effort to align our Medicare Advantage coverage with Original Medicare, effective October 19, 2015, Independent Health will no longer require prior authorization for expendable medical supplies for our Medicare Advantage members, except Medicare NYSHIP members. In addition, some codes will no longer be covered.
View the codes affected by the expendable medical supplies coverage change for Medicare members.
Although prior authorization has been removed, coverage is still based on members’ Evidence of Coverage, which states that expendable medical supplies aren’t covered “when not part of approved home skilled nursing services.”
There are some exceptions to this benefit where supplies will be covered outside of the skilled nursing care in the home requirement. We will pay for supplies when a member performs self-catheterizations or self-tracheostomy care or uses supplies in conjunction with durable medical equipment.
All services may be subject to audit for medical necessity and frequency. Local Coverage Determinations (LCDs) should be used for guidelines. You can learn more about LCDs at http://bitly.com/LCDsInfo.
If you have any questions, please call Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.