Where to Bill DMEPOS and PEN Items and Services (Rev. 1603, 10-27-08)

by  Jared Staheli
June 17th, 2015

Skilled Nursing Facilities, CORFs, OPTs, and hospitals bill the FI for prosthetic/orthotic devices, supplies, and covered outpatient DME and oxygen (refer to §40). The HHAs may bill Durable Medical Equipment (DME) to the RHHI, or may meet the requirements of a DME supplier and bill the DME MAC. This is the HHA's decision. Fiscal Intermediaries (FIs) other than RHHIs will receive claims only for the class "Prosthetic and Orthotic Devices."

Unless billing to the FI is required as outlined in the preceding paragraph, claims for implanted DME, implanted prosthetic devices, replacement parts, accessories and supplies for the implanted DME must be billed to the local carriers/MACs and not the DME MAC. The Healthcare Common Procedure Coding System (HCPCS) codes that describe these categories of service are updated annually in late spring. All other DMEPOS items are billed to the DME MAC. See the Medicare Claims Processing Manual, Chapter 23, §20.3 for additional information.

Parenteral and enteral nutrition, and related accessories and supplies, are covered under the Medicare program as a prosthetic device. See the Medicare Benefit Policy Manual, Chapter 15, for a description of the policy. All Parenteral and Enteral (PEN) services furnished under Part B are billed to the DME MAC. If a provider (see §01) provides PEN items under Part B it must qualify for and receive a supplier number and bill as a supplier. Note that some PEN items furnished to hospital and SNF inpatients are included in the Part A PPS rate and are not separately billable. (If a service is paid under Part A it may not also be paid under Part B.)

References:

• Pub 100-04 Medicare Claims Processing Manual