Effective 10/1/2017: Claims Adjudication Changes

Date: 08/24/17

Effective October 1, 2017, Buckeye Health Plan (Buckeye) - Medicaid is making changes to claim adjudication on rent to purchase of TENS Units. This letter is provided as notification of the change and also includes additional resource information related to the specific item that will be impacted.

Effective October 1, 2017 claims submitted for a TENS Unit with the appropriate CPT code and the “RR” modifier will be processed in the following manner:

Months 1 -3 will adjudicate at 10% of reimbursed fee schedule, consecutively
Month 4 will adjudicate at 70% of the reimbursed fee
Buckeye will reimburse 1 TENS Unit every 4 years
No Prior Authorization is required

Payment for short-term rental will be reimbursed at ten per cent (10%) per month of the maximum amount allowable. Providers should use the modifier “RR” when billing short-term rental. Upon decision to purchase, all prior rental payments will apply toward the allowable and the provider will receive one final payment for the remainder of the TENS Unit maximum amount. The provider will notify the consumer when an item has been purchased on their behalf.

For additional information please refer to the following links:

Please contact Buckeye’s Provider Services Department at 1-866-296-8731 should you have any questions or need assistance in accessing our website. Thank you for your partnership and for the quality care you provider to Buckeye members.