QUEST Integration – Supplies

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

Basic supplies that commonly are used in the care of illness or injury and are a standard part of facility or physician services are not payable. For facilities, these include bed pans, sheets, thermometry and other items that are part of room and board. In the emergency room/treatment room, items such as sheets/underpad chux, sterile dressing and bandages, pulse oximetry spot check, etc are considered basic supply items. In the operating room, basic supply items include but are not limited to items such as scalpels, needles, dressing, etc.

In the physician office, routine exam items such as stethoscope, gauze dressing, gloves, swabs, bandages, etc., are considered basic supplies and are not payable. However, separate payment will be considered for nonroutine supplies such as splints, cast supplies and special casting material. These supplies should be billed using the appropriate HCPCS codes.

Surgical Trays

Surgical trays are allowed for surgeries performed in the office, emergency room or hospital treatment room. Trays are not paid for surgeries performed in an ambulatory surgical center (ASC) or hospital operating room because charges for the surgical tray are included in the ASC or operating room charge.

The trays include basic surgical tray items such as scalpel, syringe, needles, scissors, sterile dressing, sterile saline, sponges, hemostat, bandages and gloves.

To bill for trays, use procedure code A4550.

Precertification Requirement

Supplies used in conjunction with durable medical equipment requires precertification only when the monthly cost of the supply is more than $500. If the patient uses several different supplies during the month, precertification is not needed as long as the monthly cost of each supply is $500 or less, even if the total cost of all supplies is greater than $500.

Precertification is obtained by sending the Precertification Request form to:

Precertification Request, 6th Floor

HMSA – Medical Management Department

P.O. Box 2001

Honolulu, HI  96805

Fax: 808-944-5611

Claims Filing Information

Use the appropriate alphanumeric HCPCS procedure code. If you are unable to determine the appropriate HCPCS code, you may use miscellaneous code 99070 or A4649; however, you must provide a description of the supply or the supply will be denied. If a miscellaneous code is used when a valid HCPCS code is available, the claim may be returned for clarification.

On the UB-92 Universal claim form, use the appropriate revenue code in conjunction with the HCPCS code.

Revision History