Change in reimbursement for DME codes billed with a UPN

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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: