Attention Durable Medical Equipment (DME) Providers: New Rates for Ostomy Equipment and Supplies

Mar 24, 2022

Yesterday, March 23, 2022, we updated the rates for ostomy equipment and supplies in MIHMS retroactive to March 1, 2022. In alignment with the intent of P.L. 2021, Ch. 467, An Act to Require MaineCare Coverage for Ostomy Equipment, we have changed the reimbursement methodology for ostomy equipment and supplies to 88.2% of current year Medicare fee schedule rates. See the updated fee schedule for details.

Adjustments for affected claims: 

• If you have been billing these codes at a higher rate than is indicated in the updated fee schedule, we will reprocess your claims and no provider action is needed.  
• If you have been billing these codes at a lower rate than is indicated in the updated fee schedule, please adjust the affected claims. Providers will have 120 days from the date of this notice to submit corrected adjustments, with the focus on the older dates of service first. 

The Department also plans to change the reimbursement methodology for all other durable medical equipment (DME) and medical supplies to 88.2% of the current year Medicare fee schedule rates, pursuant to P.L. 2021, Ch. 398, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023, and to comply with Federal Upper Payment Limit (UPL) requirements (Section 1903(i)(27) of the Social Security Act), effective this summer 2022. The Department previously issued updates regarding these broader DME rate changes on September 14, 2021, and September 24, 2021.  Additional communication about these Section 60 DME reimbursement methodology changes, including the effective date, is forthcoming.

As the intent of P.L. 2021, Ch. 467 was to increase reimbursement for ostomy equipment and supplies, the Department chose to execute an increase for these services at the 88.2% of current Medicare fee schedule rates, to align with its broader initiative under P.L.2021, Ch 398, rather than implementing the lower, 85% benchmark that was specified in P.L. 2021, Ch. 467.

Please contact your Provider Relations Specialist with questions.