Billing for Inexpensive or Other Routinely Purchased DME (Rev. 1, 10-01-03)

by  Jared Staheli
June 18th, 2015

This is equipment with a purchase price not exceeding $150, or equipment that the Secretary determines is acquired by purchase at least 75 percent of the time, or equipment that is an accessory used in conjunction with a nebulizer, aspirator, or ventilators that are either continuous airway pressure devices or intermittent assist devices with continuous airway pressure devices. Suppliers and providers other than HHAs bill the DMERC or, in the case of implanted DME only, the local carrier. HHAs bill the RHHI.

Effective for items and services furnished after January 1, 1991, Medicare DME does not include seat lift chairs. Only the seat lift mechanism is defined under Medicare as DME. Therefore, seat lift coverage is limited to the seat lift mechanism. If a seat lift chair is provided to a beneficiary, contractors pay only for the lift mechanism portion of the chair. Some lift mechanisms are equipped with a seat that is considered an integral part of the lift mechanism. Contractors do not pay for chairs (HCPCS code E0620) furnished on or after January 1, 1991. The appropriate HCPCS codes for seat lift mechanisms are E0627, E0628, and E0629.

For TENS, suppliers and providers other than HHAs bill the DMERC. HHAs bill the RHHI using revenue code 0291 for the 2-month rental period (see §30.1.2), billing each month as a separate line item and revenue code 0292 for the actual purchase along with the appropriate HCPCS code.

References:

• Pub 100-04 Medicare Claims Processing Manual