2. Children’s Medical Services Branch E-47 SAR System Authorization of Medical Supplies

3. Medical Supplies vs. Durable Medical Equipment (DME) Accessories Medical supplies are generally considered disposable, though sometimes may be used more than once. DME accessories are used as an integral part of a piece of DME. DME accessories may be reused for longer periods of time. DME accessories use a DME code, e.g. E0450.

4. What are Valid Medical Supply Codes? 4 numeral digits plus an alpha character, eg. 9987K as listed in Medi-Cal Manual. First 2 digits are always “99”. 2 additional alpha characters added at the end of the 5 digit code represent the manufacturer’s code, e.g. 9987KRM. Requests using only a 5 digit code may be authorized, without regard to the 2 digit manufacturer code.

5. What are Valid Medical Supply Codes? 11 digit NDC code for diabetic medical supplies, e.g. 00193391125. Effective Nov. 1, 2004, Department has negotiated contracts with diabetic supply manufacturers. Diabetic medical supplies with NDC/UPC codes are lancets and test strips.

6. What are Valid Medical Supply Codes? For dates of service on or after Nov. 1, 2004, requests for lancets and test strips without NDC/UPC codes are not acceptable. NDC codes may only be authorized to contracted pharmacies. NDC codes for diabetic supplies may be found in SAR Formulary. NDC codes for diabetic supplies may be authorized in SAR system under Medical Supplies.

7. Quiz: Medical Supply or DME Accessory Code? A4660 9928D RM9987K 00193654621 X3699 DME Accessory Medical Supply Diabetic Medical Supply DME Accessory

8. What if a Specific Medical Supply Code Does Not Exist? Miscellaneous codes are listed in the Provider Manual. May not use the misc. code if a specific code generally describes the item. Incorrect use of a misc. code may result in non-payment.

9. What About an Unlisted Code or Unknown Manufacturer? 9999A = Unlisted medical supply. ZZ manufacturer code not listed in CMS Web. These codes may be used when no listed code applies and the misc. code in the general item category does not apply. Most often used with new item. Requires “by-report”, listing item description, manufacturer, and item number in special instructions.

10. What if Code is Not Listed in the Web-based System? Don’t guess, Contact provider to obtain correct code, Clarify if requested item is medical supply or DME item or accessory,

11. What if Code is Not Listed in the Web-based System? Check to see if there is a miscellaneous item supply code listed, Inquire if 9999A is appropriate, Refer to Medi-Cal Allied Health Provider Manual for list of all medical supply codes at www.medi-cal.ca.gov.

12. UNITS For medical supply codes (4 numeric digits followed by an alpha character), multiply out total number to be authorized within the effective dates, e.g. 100 gloves per mo. for 6 mos. = 600 units. For NDC codes (lancets and strips), enter # of fills + refills.

13. QUANTITY (Pharmacy Only) Quantity field is only used for NDC codes. Only NDC codes requiring prior authorization are drugs on the excluded list and diabetic supplies (lancets and strips). Enter number to be authorized per unit in quantity field.

14. Medi-Cal Manual Example KARAYA GUM POWDER Karaya Gum Powder, Karaya Paste and Stomahesive Paste/Powder is limited to a cumulative total of no more than 12 ounces in a 30-day period, per recipient, without prior authorization. † Regular1.05 ounces9981Lounces † 2.45 – 4.20 ounces9981Mounces † 11.90 – 16.80 ounces9981Nounces † Sterile1.05 ounces9981Pounces † 2.45 – 4.20 ounces9981Rounces † 11.90 – 16.80 ounces 9981Sounces †

15. Sample SAR from Pharmacy 16. CPT- 4/HCPCS Codes/NDC 17. Description of Services 18. From: (mm/dd/yy) To: (mm/dd/yy) 19. Frequency /Duration 20. Units 21. Quantity 53885024510One Touch Ultra Test Strips (4/25 – 100) 08/01/0401/31/05200/mo. for 6 months 6200 53885039310One Touch Ultra Soft Lancets (100) 08/01/0401/31/05200/mo. for 6 months 6200 9926JBD Insulin syringe ½ cc (100’s) 08/01/0401/31/05200/mo for 6 months 1200 9926ANovofine Hypodermic Needles 08/01/0401/31/05100/mo for 6 months 600 Z5822Bilateral hearing aid batteries 08/01/0401/31/0518/aid Per quarter 72 9981ACleansing wash 3785cc/bottle 08/01/0401/31/051 bottle / mo. 22,710 Must divide over 3 entries of 7570 ea.

16. Sample SAR from Pharmacy 16. CPT- 4/HCPCS Codes/NDC 17. Description of Services 18. From: (mm/dd/yy) To: (mm/dd/yy) 19. Frequency /Duration 20. Units 21. Quantity 9980RSLSWEEN CREAM 230- 270 GMS 08/1/0401/31/051 tube per mo. 1620 9981MBCKARAYA POWDER 3- 1/2OZ-99GRAMS 08/1/0401/31/051 container per mo. (multiply oz/containe r 24