Effective December 1, 2023, there will be some changes in reimbursement for durable medical equipment (DME) codes billed with a Universal Product Number (UPN).
To align with Medi-Cal guidelines, all secondary claims submitted with a UPN for the following codes will be priced based off UPN pricing and benefits coordinated:
- A4215.
- A4351.
- A4352.
- A4605.
- A4623.
- A4624.
- A4629.
- A7520.
- A7521.
- A7525.
- A7526.
- A7527.
For claims submitted without a UPN, pricing will remain the same and will be based on Other Health Coverage (OHC) allowed amounts.
For more information, review the following resources:
- DHCS Medi-Cal Learning Portal: Medical Supplies Workbook: thealliance.health/medical-supplies-workbook
- DHCS Medi-Cal Providers Medical Supplies: thealliance.health/dhcs-mc-sup
