Children’s Medical Services Branch

E-47 SAR System

Authorization of Medical Supplies

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.

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.

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.

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.

Quiz:Medical Supply or DME Accessory Code? A4660

9928D

RM9987K

00193654621

X3699

DME Accessory

Medical Supply

Medical Supply

Diabetic Medical Supply

DME Accessory

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.

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.

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,

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.

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.

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.

Medi-Cal Manual ExampleKARAYA 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. † 

Regular 1.05 ounces 9981L ounces †2.45 – 4.20 ounces 9981M ounces †11.90 – 16.80 ounces 9981N ounces †

 Sterile 1.05 ounces 9981P ounces †

2.45 – 4.20 ounces 9981R ounces †11.90 – 16.80 ounces 9981S ounces †

  

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

53885024510

One Touch Ultra Test Strips (4/25 – 100)

08/01/04 01/31/05 200/mo. for 6 months

6 200

53885039310

One Touch Ultra Soft Lancets (100)

08/01/04 01/31/05 200/mo. for 6 months

6 200

9926J BD Insulin syringe ½ cc (100’s)

08/01/04 01/31/05 200/mo for 6 months

1200

9926A Novofine Hypodermic Needles

08/01/04 01/31/05 100/mo for 6 months

600

Z5822 Bilateral hearing aid batteries

08/01/04 01/31/05 18/aidPer quarter

72

9981A Cleansing wash3785cc/bottle

08/01/04 01/31/05 1 bottle / mo.

22,710Must divide over 3 entries of 7570 ea.

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

9980RSL SWEEN CREAM 230-270 GMS

08/1/04 01/31/05 1 tube per mo.

1620

9981MBC KARAYA POWDER 3-1/2OZ-99GRAMS

08/1/04 01/31/05 1 container per mo. (multiply oz/container

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