Medicare Coverage Updated for DME Procedure Codes

On January 16, 2018, NCTracks was updated to reflect Medicare coverage for several DME procedure codes. If a primary claim for the affected DME procedure codes is billed to Medicaid for a Medicare eligible recipient, the claim will deny with edit 00274 - MEDICARE COVERED DME FOR MEDICARE ELIGIBLE RECIPIENT and Explanation of Benefits (EOB) 01274 - FOR RECIPIENTS WITH MEDICARE, MEDICAID WILL ONLY REIMBURSE FOR THIS DME ITEM IF MEDICARE HAS ALLOWED OR PAID. Providers will need to bill the affected DME procedure codes to Medicare first for dually eligible recipients.