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Durable Medical Equipment/Supplies (DME/DMS)
Q1. What copayments apply for DMS under the Benchmark Plan?
A1. Copayments for DMS under the Benchmark Plan only apply to procedure
codes A4206-A4215 (syringes and diabetic pens). Copayments do not apply to other
DMS items covered under the Benchmark Plan. Copayment amounts are the same under
the Benchmark Plan as they are under the Standard Plan (i.e. current Wisconsin
Medicaid program). If the copayment amount is greater than the maximum allowable
fee for an item, the member should be charged the maximum allowable fee.
(See BadgerCare Plus Update 2007-89).
Q2. What are the quantity limits for disposable supplies under the
Benchmark Plan?
A2. Per BadgerCare Plus Update 2007-89, "Coverage limitations applicable to
the procedure codes listed in the Attachment are the same as those under the
current Wisconsin Medicaid program. Refer to the current DMS Index for those
limitations." The DMS Index can be found at the following link: http://www.wisconsinedi.org/dms/search.do
Q3. What are the DMS copayments under the Standard plan?
A3. DMS copayments under the Standard Plan are the same as they are under the
current WI Medicaid Program. All copayments are listed in the DMS Index:
http://www.wisconsinedi.org/dms/search.do
Q4. How will a supplier be able to know if a member is reaching their
annual cap for benefits in this area?
A4. The provider can call Provider Services at (800) 947-9627 or (608) 221-9883
for this information.
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Last Revised: October 24, 2008
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