Can a DME bill under Medicare code 94660??

Ok, I complained about this last week, and now I have more info. I went in to my DME to pick up a mask and the other typical supplies which all happen to be covered 100% by my insurance and aren't subject to my deductible. In the past this never netted a charge to me. This time I get a charge against my deductible for billing code 94660 "CPAP Initiation and Management," which is a diagnostic service and therefore goes against the deductible.

Looking this code up online has yielded some interesting (mostly depressing!) links mainly written by sleep doctors on how to maximize thier billing along with hints from both Phillips and Resmed on the same thing. But, from what I read, this a charge from a PHYSICIAN setting up a patient on CPAP or maybe reading data from the machine and discussing it with the patient. I see nothing about it being a charge a DME can make when handing me a new mask, and at the same time ignoring the data card in my hand completely. (I was curious to see if they'd read it, and how helpfull they might be - silly me!)

The DME billed insurance $150 under this code, and my insurance allowed $60 - which means I owe $60 to the DME for absolutely no service rendered short of providing me the priveledge of buying supplies from them.

So, anyone else have experience with this code? I'm fighting it....

Resmed link on billing: http://www.resmed.com/us/documents/1013 ... nloads.pdf

Even if you're not on Medicare, try calling Medicare (1-800-MEDICARE) and ask them if that's an appropriate billing code (called a CPT code) for the DME to use. Most insurers follow Medicare guidelines on those things, so if Medicare would not reimburse a DME for providing service under that billing code, then more than likely your insurer wouldn't either. You can also call your insurer directly to ask, but you may be told that information is "proprietary".

When I get supplies from my DME (pick up), I sign for the items I received...in fact, they fill out an order and show how much Medicare allows and how much I have to pay. Usually I pay my share when I receive the goods.

Yep - I signed the bottom of an itemized form as well listing every item I recieved. This charge was not on that list...

If a service is not provided it should not be billed for. Handing someone a mask is not a service that falls under the description of that procedure code. They are padding their pocket..most people just get a bill and pay it and never look. That is what they were counting on. Screams fraud to me.

I don't blame you for being pissed. I would be seeing red.
I would be challenging it also.
I would also be finding a new DME.

Likewise the office visits I have been billed for when visiting my DME office strictly for picking up supplies were NOT on the code sheet when I signed it. Billed to insurance: $20 for filters, $60 for nasal pillows, $140 for office visit.

The only questions asked/answered was the sales guy asking if I wanted to be set up for automatic supply replacements (2 filter/mo, 2 pillows/mo, 2 nasal mask setups/yr, 1 humidifier water chamber/yr.

I told him I thought my insurance company may require I buy from the Medco pharmacy like my monthly maintenance meds. But really I figure to go to cpap.com, because the pricing is so much better - and that will make a hell of a difference when I start on next year's $2400 deductible! THIS year, the sleep study ate up the deductible right off the bat.

I bet you are pissed! I know I would be! That's probably why my DME wanted me to come in for a fitting instead of having a new mask shipped to me.
Call your insurance company.
You have nothing to lose. Then I would shop for a new DME.
It ticks me off when they rip off my insurance company and then try to take it out of my pocket. How dumb do they think we are?

Edit: You got my blood boiling and it's bedtime... Now that's bad sleep hygiene. What do I do now?

Yeah, I'm pretty worked up about it alright! The funny thing is I'm getting a new script written tomorrow for a new flow generator, and have a little leverage to apply. So far my insurance has not done much about it - I called them last week and told them it was a fraudulent charge, and they were going to call and discuss it with the DME then get back to me by 4/17. As of yesterday evening they had not done it yet...

Just had a call with the woman that handles all the CPAP ordering and scheduling. That was real useful... Her response is they bill that code every time you go in and see an RT to get a new mask. She said the description of the code is misleading; not sure why Medicare uses the terminology such as "physician" or "maintenance". Got a little annoyed when I pointed out Medicare created the codes and descriptions, that maybe the DME was one confused on the usage not Medicare.

Wanted to know what I wanted done... Told her I wasn't paying a dime for that non-service and that how they respond to that would determine whether or not they ever got to bill my insurance again. Her response - what's a number a manger can call you at?

I am getting really fed up with the entire healthcare system. It appears to me a lot of providers are pulling this crap to try and get more out of you lately. I'm also in a dispute with the local emergency room physicians. We took our youngest in when he was 14 months last year for a stomach flu and they billed insurance a $60 "afterhours surcharge." Since insurance rejected it as bogus they billed me. Insurance to me they were paid at emergency physician rates, and to add that surcharge was ludicrous. They are by definition afterhours docs; they can't bill extra for what is a regulr service of thiers. BTW - we never saw the physician they billed us for; just a young PA. Still fighting this one!

No they cannot. This is a CPT code used by a Physician if the item is set up in their office. I can almost assure you that they are trying to collect from you because they had their claim denied as non covered. DME bill HCPC codes and Physicians, facilities and hospitals bill CPT codes to Insurers and Medicare Part B. I would be curious to know how many people they actually got to pay for this. Where are you located?

Could you please register so people can PM you?
Also let us know a bit about yourself.
Welcome.

I think he did after making that post. I saw medbillingconsultant or something close listed online when I first read his post. Could be a valuable tool on here!

Using his info I did some searching and see that his info appears correct - they are billing under a physician's code as opposed to a dme code. The reason is clear in this document: http://www.resmed.com/us/documents/1013 ... nloads.pdf - about the only code available to the DME for such a charge is not payable by medicare...

While I was there the RT complained that they hated dealing with United Healthcare as they did not get paid much under thier contract. So, they are trying to backdoor some more cash through that other code.

Update from United: She has tried several times but cannot get through to a person at my DME (I always can?!?). She's still trying. Oh, and she has no direct line, so they and I cannot call her back?!? Very frustrating!

Further update - spoke to another local DME, and they said if a patient sees an RT they also bill 94660... Interesting!

It is like a poker game--only with OUR money-not their own.
Ah, but if only one could put a camcorder under the card table!