General Billing Requirements - for DME, Prosthetics, Orthotic Devices, and Supplies (Rev. 330, 04-04-05)

by  Jared Staheli
June 18th, 2015

Part B suppliers and providers other than Home Health Agencies (HHAs) must bill DMEPOS to the Durable Medical Equipment Regional Carrier (DMERC), except claims for implanted DME. Implanted DME and supplies for the implanted equipment are billed to the local carrier.

Suppliers and providers must have a supplier billing number issued by the National Supplier Clearinghouse (NSC) prior to billing the DMERC.

Institutional providers bill their FI for prosthetics and orthotics devices and supplies. Generally, Medicare does not pay for DME in a facility. For hospital outpatient DME, bills go to the appropriate DMERC.

DMEPOS provided under a home heath plan of care may be billed either by the HHA or by the supplier (including the HHA with a supplier number if the HHA prefers to bill that way) to the DMERC. If the HHA chooses to bill to the RHHI, the HHA includes the DME on the PPS claim (32x or 33x). If the beneficiary is not under a plan of care and receives DMEPOS from a HHA, the agency uses bill type 34x.

Beneficiary Submitted Claims must contain an enrolled Medicare Supplier Number.

References:

General Billing Requirements - for DME, Prosthetics, Orthotic Devices, and Supplies (Rev. 330, 04-04-05). (2015, June 18). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/general-billing-requirements-for-dme-prosthetics-orthotic-devices-and-supplies-rev-330-04-04-05-26732.html

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