Update on M Factor Fee Schedule Alert Dated 6/15/21

Date: 09/01/21

Iowa Total Care (ITC) is publishing this Alert to update providers on the information included in the Provider Alert dated June 15, 2021.

ITC will implement a M factor fee schedule change September 1, 2021.

Durable Medical Equipment, including diabetic supplies billed with dates of service 10/9/2020 and after, will reimburse at the following:

• For codes with a published Average Wholesale Price (AWP) the reimbursement rate* will be that AWP less 10%, OR,

• For codes without a published AWP [included in this Durable Medical Equipment (DME) Procedure Codes table (PDF)], ITC will reimburse at:

1) Manufacturer Suggested Retail Price (MSRP) less 15%, OR
2) Invoice plus 10%.

*Rates are updated quarterly on the first day of the quarter.

Any providers with claims that were calculated under the previous methodology specific to the codes included in the mentioned DME table (PDF) above, may take the following action:

• Submit the invoice or MSRP statement through the dispute process outlined in the Iowa Total Care Billing Manual (PDF) (page 44) for review and reconsideration, OR

• Submit a corrected claim with invoice or MSRP through the ITC Provider Portal.

If your impacted claims have exceeded the current extended timely filing limits (270 days from the last adjustment) for corrected claim submission or dispute process, alert your Provider Relations Specialist prior to submitting to avoid any additional delays in reprocessing.