Services Billed to the DME MAC for Indian Health Services (Rev. 1040, 09-11-06)

by  Jared Staheli
June 25th, 2015

Effective July 1, 2005, IHS suppliers and IHS providers (including CAHs) shall bill the appropriate DME MAC for DME.

Although, parenteral and enteral nutrients, equipment, and supplies meet the definition of the prosthetic benefit, they are separately billable to the DME MAC for home use. Ostomy, tracheostomy, and urological supplies meet the definition of this benefit and are billed to the DME MAC by IHS suppliers. See §120 of Chapter 15 of Pub. 100-02, Medicare Benefit Policy Manual for more information on this benefit.

Claims for surgical dressings provided by IHS suppliers shall be billed to the appropriate DME MAC. Claims for splints and casts provided by IHS suppliers should be billed to the appropriate carrier. See §100 of Chapter 15 of Pub. 100-02, Medicare Benefit Policy Manual for more information on this benefit.

Effective July 1, 2005, Medicare Part B payment may be made to IHS suppliers that furnish drugs covered by the DME MAC. The DME MAC drug categories are oral anticancer, oral anti-emetic, immunosuppressives, and drugs used for with DME, such as external infusion pumps and nebulizers. Medicare Part B drugs incident to a physician’s service shall be billed to the designated carrier when provided in freestanding facility. See §80, Chapter 17 of Pub. 100-04, Medicare Claims Processing Manual for more information on this benefit.

Effective July 1, 2005, Medicare Part B payment shall be made to IHS suppliers and IHS providers (including CAHs) functioning as retail pharmacies dispensing pharmaceuticals to AI/AN Medicare beneficiaries. These drugs are billed to the appropriate DME MAC. The FI shall not be billed for these drugs. Drugs dispensed for self-administration are only covered when billed to the DME MAC if also specifically covered under Medicare.

Effective July 1, 2005, Medicare Part B payment may be made by the appropriate DME MAC to IHS suppliers that furnish therapeutic shoes and inserts for individuals with diabetes. See §140 of Chapter 15 of Pub. 100-02, Medicare Benefit Policy Manual for more information on this benefit.

References:

Services Billed to the DME MAC for Indian Health Services (Rev. 1040, 09-11-06). (2015, June 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/services-billed-to-the-dme-mac-for-indian-health-services-rev-1040-09-11-06-26830.html

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