Statutes, codes, and regulations
Wyoming Administrative Code
Agency 053 - Workforce Services, Department ofSubagency 0021 - Workers' Compensation Division
Chapter 9 - FEE SCHEDULES
Section 9-4 - Fees for Supplies, Implants, Durable Medical Equipment (DME), Orthotics and Prosthetics

053-9 Wyo. Code R. § 9-4

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Current through April 27, 2019
Section 9-4 - Fees for Supplies, Implants, Durable Medical Equipment (DME), Orthotics and Prosthetics

(a) The Division adopts the Wyoming Medicare rate of the Healthcare Common Procedure Coding System (HCPCS) as the rates were published as of January 1, 2015 for the payment of supplies, DME, orthotics and prosthetic devices prescribed by a health care provider. See Chapter 9, Section 1 for additional guidelines. The Division shall not pay for any supplies, DME, orthotics, or prosthetics unless prescribed by the primary health care provider.

  • (i) The Division has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;
  • (ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection a of this section;
  • (iii) The incorporated code, standard, rule or regulation is maintained at 1510 East Pershing, Cheyenne, WY 82002 and is available for public inspection and copying at cost at the same location.

(b) Each code incorporated by reference in these rules is further identified as follows:

  • (i) Reference to Wyoming Medicare rate of the Healthcare Common Procedure Coding System (HCPCS) is adopted by the Division and effective on January 1, 2015, found at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html

(c) Any related charges for supplies, DME, orthotics and prosthetics not listed in the Medicare HCPCS fee schedule shall be paid at eighty percent (80%) of billed charges. Charges deemed excessive shall require additional documentation for justification.

  • (i) Any single supply / implant charged at $1,000.00 or more shall require a suppliers' invoice. Reimbursement shall be at 130% of invoice cost. Shipping and handling charges shall not be reimbursed.
  • (ii) The Division shall not provide direct payment to suppliers or manufacturers for implantable items.

(d) The preceding fees are not intended to address newly developed items or technologies.

053-9 Wyo. Code R. § 9-4

Amended, Eff. 12/12/2017.

Amended, Eff. 5/23/2018.