Application of DMEPOS Fee Schedule (Rev. 1, 10-01-03)

by  Jared Staheli
June 18th, 2015

Services that are paid under the DME fee schedule are identified in the DMEPOS fee schedule file available free on the CMS Web Site at: http://www.cms.hhs.gov/providers/pufdownload/default.asp

The DMEPOS fee schedule applies to claims to FIs as follows.

BILL TYPE/ DEFINITION ORTHOTICS/ PROSTHETICS DME/ OXYGEN
12X (Hospital inpatient Part B) Subject to fee schedule Not covered, therefore, not subject to fee schedule
13X (Hospital Outpatient) Subject to fee schedule Subject to fee schedule
22X (SNF inpatient Part B) Subject to fee schedule Not covered, therefore, not subject to fee schedule
23X (SNF outpatient) Subject to fee schedule Subject to fee schedule
*32X (HHA visits under Part B Plan of Care) Subject to fee schedule Subject to fee schedule
*33X (HHA visits under Part A Plan of Care) Subject to fee schedule Subject to fee schedule
34X (HHA visits not under a Plan of Care) Subject to fee schedule Subject to fee schedule
71X Rural health clinics (Provider-based only) Subject to fee schedule Subject to fee schedule
74X (Outpatient PT) Subject to fee schedule Subject to fee schedule
75X (CORF) Subject to fee schedule Subject to fee schedule
**83X ASC Subject to fee schedule Subject to fee schedule
85X RPCH Subject to fee schedule Subject to fee schedule

* HCPCS codes A4214, A4310 through A4455, A4481, A4622, A4623, A4625, A4626, A4629, and A5051 through A5149 are excluded from the fee schedule when billed by a HHA to its RHHI under these bill types. Also, when billed on type of bill 32x or 33, catheter and ostomy supplies are considered non-routine supplies and are billed with revenue code 027x.

** HCPCS codes A4214, A4310 through A4330, A4338 through A4359, and A5102 through A5114 are excluded from the fee schedule when billed by a non-OPPS hospital with an ASC service under this bill type. In addition, HCPCS codes A5119 through A5131 can be excluded or included in the fee schedule depending on the procedure in which they are associated.

NOTE: Bill types not listed are not subject to the fee schedule for either orthotics/ prosthetics or DME/oxygen with the exception of provider-based Federally Qualified Health Centers (FQHCs). Orthotics/prosthetics and DME/oxygen furnished by providerbased FQHCs are subject to the fee schedule. However, bill type 73X is not reflected in the above chart since FQHCs use the bill type for the parent provider (usually 13x).

Bill types listed above are billed to the FI for orthotics/prosthetics.

Providers other than HHAs bill the DMERC for DME/oxygen. HHAs bill their RHHI for DME/oxygen.

DME billing is not required on Home Health PPS claims. Home Health Agencies retain the option to bill services to Regional Home Health Intermediaries (RHHI) or have services provided under arrangements with a supplier that bills the DMERC.

References:

Application of DMEPOS Fee Schedule (Rev. 1, 10-01-03). (2015, June 18). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/application-of-dmepos-fee-schedule-rev-1-10-01-03-26737.html

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