CurrentHighmark PennsylvaniaPolicy N/A

Medicare Advantage capped rental items HCPCS mapping

Lists HCPCS code mappings and purchaseable item equivalents for Medicare Advantage capped rental durable medical equipment. Affects billing/coding for providers submitting claims to Highmark Pennsylvania.

Policy Summary

PayerHighmark Pennsylvania

PolicyMedicare Advantage capped rental items HCPCS mapping

Policy CodePolicy N/A

Change TypeInformational — coding/mapping guidance

Effective DateN/A

Next Review DateN/A

Key ActionUse the provided HCPCS mappings to bill Medicare Advantage capped rental items or the corresponding purchaseable item codes when submitting claims.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6document chunks

manyHCPCS code mappings listed

HCPCS Mapping and Rental/Purchase Rules

Sample HCPCS Mappings Table

sample mappingsCPT

A7025	HCPCS code listed as capped rental item
E0302	HCPCS code mapped to multiple equivalents in list
K0835	Example purchaseable item equivalent

MEDICARE ADVANTAGE CAPPED RENTAL ITEMS HCPCS (additional examples)HCPCS

E0303	Mapped equivalent for A7025, E0302
E0762	Mapped equivalent for A7025, E0749
E1035	Mapped equivalent for A7025, E1031
E1270	Mapped equivalent for A7025, E1240
E2374	Mapped equivalent for A7025, E2373
E0304	Mapped equivalent for E0117, E0302
E0764	Mapped equivalent for E0117, E0749
E1036	Mapped equivalent for E0117, E1031
E1280	Mapped equivalent for E0117, E1240
E2375	Mapped equivalent for E0117, E2373

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Policy Summary

PayerHighmark Pennsylvania

PolicyMedicare Advantage capped rental items HCPCS mapping

Policy CodePolicy N/A

Change TypeInformational — coding/mapping guidance

Effective DateN/A

Next Review DateN/A

Key ActionUse the provided HCPCS mappings to bill Medicare Advantage capped rental items or the corresponding purchaseable item codes when submitting claims.

SourceLink

On This Page

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Billing and Submission Guidance

Billing Rule

MEDICARE ADVANTAGE CAPPED RENTAL ITEMS HCPCS

For Medicare Advantage billing, certain HCPCS-covered items are subject to capped rental rules and must be billed as rentals unless replaced by the corresponding purchaseable HCPCS code listed below. Submit the purchase code when the item is purchased rather than rented.

A7025 → purchaseable mappings: E0303, E0762, E1035, E1270, E2374
E0117 → purchaseable mappings: E0304, E0764, E1036, E1280, E2375, K0835
E0140 → purchaseable mappings: E0305, E0779, E1037, E1295, E2376, K0836
E0144 → purchaseable mappings: E0316, E0781, E1038, E1700, E2377, K0837
E0149 → purchaseable mappings: E0371, E0784, E1039, E1800, E2378, K0838
E0165 → purchaseable mappings: E0372, E0791, E1050, E1801, E2402, K0839
E0170 → purchaseable mappings: E0373, E0849, E1060, E1802, K0001, K0840

Medicare Advantage Capped Rental Items — Definitions

MEDICARE ADVANTAGE CAPPED RENTAL ITEMS HCPCS

Primary mapping examplesA7025 maps to E0303, E0762, E1035, E1270, and E2374 (shown as: A7025, E0302 = E0303; A7025, E0749 = E0762; A7025, E1031 = E1035; A7025, E1240 = E1270; A7025, E2373 = E2374).

Purchaseable item mapping (example A7025)A7025 is indicated as having items that can be purchased (document states: 'A7025, Items that can = be purchased:*').

Alternate base code E0117 mappingsE0117 maps to E0304, E0764, E1036, E1280, and E2375 and is listed as having purchasable items (E0117, Items that can = K0835).

Alternate base code E0140 mappingsE0140 maps to E0305, E0779, E1037, E1295, and E2376 and is listed with purchasable item equivalent K0836 ('E0140, Items that can = K0836').

Additional sample mappings (E0144, E0149, E0165, E0170)E0144 → E0316, E0781, E1038, E1700, E2377 (purchasable K0837); E0149 → E0371, E0784, E1039, E1800, E2378 (purchasable K0838); E0165 → E0372, E0791, E1050, E1801, E2402 (purchasable K0839); E0170 → E0373, E0849, E1060, E1802, E2373 → K0001 (purchasable K0840).