Most medical services are included in a standard fee schedule. However, some services are not included in a standard fee schedule because they are unique. This includes specific durable medical equipment (DME).

For specific DME, CHPW must verify the actual manufacturer’s suggested retail price (MSRP) in order to provide pricing. Miscellaneous wheelchair parts (HCPC K0108) is one.

Please specify the actual MSRP for each K0108 item billed. This allows for faster processing of your claim. This applies for all CHPW plans/lines of business.

  • Electronic claim: Loop 2400, SV1 segment (Service Line Number)

Example (X-12)

  • Paper claim: You can attach a sheet with the MSRP; or include the authorization for the item; or make a note on the claim

Example