Using the DMAP fee-for-service (FFS) fee schedule
What the DMAP FFS fee schedule tells me
The FFS fee schedule provides general information on the Healthcare Common Procedure Coding System (HCPCS) Level II codes, such as:
- The maximum allowed payment
- The effective date of the current rate
What the DMAP FFS fee schedule does NOT tell me
The following information is not covered in the DMAP FFS fee schedule, but is covered in the DMEPOS Oregon Administrative Rules (OARs) under specific codes or code categories:
- Whether a DMEPOS provider can bill for a particular code
- Whether prior authorization (PA) is required
- Which restrictions, limitations or exclusions apply, if any
- Which conditions of coverage apply, if any
- Any other rules I need to consider
What else do I need to know?
- The FFS fee schedule must be used in conjunction with all applicable OARs.
- The FFS fee schedule is normally updated every other month.
What charge do I enter on my claim?
Bill your usual charge. See General Rules, OAR 410-120-0000 Acronyms and Definitions - (185) Usual Charge (UC).
How much will DMAP reimburse me?
The usual charge, the manufacturer's suggested retail price or DMAP's maximum allowable rate, whichever is lowest.