MedicaidReimbursementMedium impact
DME Payment Procedures; Coverage for Apnea Monitors and Supplies
Maryland Medicaid·MD · Sleep Medicine, Pulmonology, Pediatrics·Medical Supply and Equipment
Effective date
Aug 1, 2007
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has updated DME payment procedures allowing providers to choose between MSRP minus 40% or wholesale cost plus 30% reimbursement methods, with 90-day recalculation requests allowed. For apnea monitors, supplies (belt kits, electrodes, lead wires) are now included in the monthly rental fee and will no longer be reimbursed separately.
Action Required
By August 1, 2007: Stop billing separately for apnea monitor supplies including belt kits (A9999), electrodes (A4556), and lead wires (A4557) as these are now included in the monthly rental fee. Update billing system to reflect that apnea monitor supply codes should not be billed separately. For DME without established rates, document choice of reimbursement method (MSRP minus 40% or wholesale cost plus 30%) and ensure any recalculation requests with supporting invoices are submitted within 90 days of initial payment.