DME Fee Schedule Effective 20160701

NYS Medicaid DME Services Fee Schedule ( Effective 7/1/2016)CODEDESCRIPTIONFEERENTAL FEEBRA4216 STERILE WATER, SALINE AND/OR DEXTROSE, WATER/SALINE,500 FOR MAINTENANCE OF DRUG SET FOR EXTERNAL INSULIN PUMP, SET FOR EXTERNAL INSULIN PUMP, BATTERY, ALKALINE (OTHER BATTERY, ALKALINE, J CELL, BATTERY, LITHIUM, FOR USE OR PEROXIDE, PER WIPES, PER OR PHISOHEX SOLUTION, PER TEST OR REAGENT STRIPS OR KETONE TEST OR REAGENT STRIP, GLUCOSE TEST OR REAGENT STRIPS , LOW AND HIGH CALIBRATOR DEVICE FOR LANCET, , PER BOX OF , PER SUPPLY, CONDOM, MALE, SUPPLY, CONDOM, FEMALE, TRAY WITHOUT DRAINAGE BAG TRAY WITHOUT DRAINAGE BAG TRAY WITH DRAINAGE BAG WITH TRAY WITH BULB OR PISTON SYRINGE, BULB OR PISTON, EXTERNAL CATHETER WITH INTEGRAL DRAINAGE TUBING, ANY TYPE, CATHETER ANCHORING DEVICE, CATHETER ANCHORING DEVICE, LEG SUPPLY MISCA4338 INDWELLING CATHETER; FOLEY TYPE, CATHETER, FOLEY TYPE, CATHETER; FOLEY TYPE, THREE EXTERNAL CATHETER, WITH OR URINARY CATHETER; URINARY CATHETER; COUDE ( URINARY CATHETER, WITH TRAY WITH DRAINAGE BAG BUT URETHRAL CLAMP OR COMPRESSION DRAINAGE BAG, DAY OR NIGHT, DRAINAGE BAG, LEG OR ABDOMEN, FACE PLATE, BARRIER; SOLID, 4 X 4 OR CLAMP, ANY TYPE, REPLACEMENT , LIQUID OR EQUAL, ANY TYPE, VENT, ANY TYPE, BELT, FILTER,ANY TYPE, 1 of 34 NYS Medicaid DME Servic))

nys medicaid dme services fee schedule (effective 7/1/2016) code description fee rental fee br a4216 sterile water, saline and/or dextrose, d 0.43 a4217 sterile water/saline,500 ml 1.58 a4221 supplies for maintenance of drug infusio 1.00 a4230 infusion set for external insulin pump, 15.05 a4231 infusion set for external insulin pump, 6.27

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