CPT CODES MODIFIERS
What is E1399?
E1399 is a Miscellaneous durable medical equipment
It is utilized for items that do not have a more specific code assigned to them, including accessories for oxygen delivery devices and other medical supplies. This code serves as a general classification for medical equipment that lacks detailed designated codes, allowing for billing in cases where no specific code exists.
What should go on the " TAG"
Member / DEP code, CPT CODE
EX: 00 E0601 E0562
If you are uncertain about an internal review who should you ask ?
Marion, Veronica or Liset
What is a RX?
Prescription
Continuous Positive Airway Pressure
After we receive a denial or approval from our medical consultant what field should be filled out ?
APPROVAL/ DENIED FIELD
I received a prescription for an over-the-counter shoulder brace I can internally review and approve for the DX on file. Patient had shoulder surgery on 09/1/2025
TRUE / FALSE
False,
plan does not cover over the counter items
PPO
Preferred Provider Organization
Heated Humidifier
What should be mentioned on the comment section when sending to review ?
pre/ post/ urgent
CPT SENT TO REVIEW
DOS/ DATE RANGE
additional comments to help call reps that are reviewing corro
I receive a hearing aid claim I can do an internal review if I have a ___________.
Before sending to review where should we look for the CPT definition?
HINT: we should also check if there is a UM
WGS
If an item is Rented (RR) how long do we pay for this item ?
Rent to Purchase price
10 mo.
True / Falso
.AHI LEVELS?
MINIMAL
MILD
MODERATE
SEVERE
LESS THAN 5 MINIMAL
5-15 MILD
16-30 MODERATE
OVER 30 SEVERE
What does CGM stand for ?
Continuous glucose monitoring
When we receive a E139 claim how should we handle?
-Pull paper claim and identify the item
-Is this payable under the plan
- Does this need review ?
-Pend for medical records if we need to review
-Deny if it is a plan exclusion.
- Add message with item description and reason for review or denial
Ex- Spouse is calling to see the determination of her daughters claim/ review. She is frustrated because it is taking very long, she is expressing she need an update on this request. I do not want to make her more upset so I will give her the determination of the review. She is clearly aware that it is pending and the answer is in the corro notes.
TRUE/ FALSE
FALSE, if ex-spouse is not on the plan we cannot give her this information unless there is a ____ form on file.
What Chronic diagnosis are okay to allow a MILD AHI level?
5-15
Chronic obstructive pulmonary disease
Heart Disease
Diabetes
Kidney Failure
What does DME stand for ?
Durable Medical Equipment