HCPCS - DME, Drugs, and Services



DME
 

 

Reimbursement for most Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is established by fee schedules. Payment is limited to the lower of the actual charge or the fee schedule amount.

The fee schedule classifies most DMEPOS into one of six categories explained below:

  1. Inexpensive or other routinely purchased DME
  2. Items requiring frequent and substantial servicing
  3. Customized items
  4. Other prosthetic and orthotic devices
  5. Capped rental items
  6. Oxygen and oxygen equipment

For some basic information to get you started including modifiers and how CMS views DMEPOS CLICK HERE

Code Sets

HCPCS Codes

HCPCS Procedure & Supply Codes

Drugs Administered HCPCS Codes

J0120‑J9312: Drugs Administered HCPCS Codes

Oncology Drugs HCPCS Codes

J8670‑J9999: Oncology Drugs HCPCS Codes

Find-A-Code's Tools & Resources

DMEPOS Product Search

Quick Product and HCPCS Code Look Up Tool

Check-A-List

Use this tool to create and complete checklists for DME

General Links and Resources

CMS DMEPOS Transmittals

Durable Medical Equipment (DME) Center

CME MAC JA LCDs

DME MAC Jurisdiction A Active LCDs

DME MAC JB LCDs

DME MAC Jurisdiction B Active LCDs

DME MAC JC LCDs

DME MAC Jurisdiction C Active LCDs

DME MAC JD LCDs

DME MAC Jurisdiction D Active LCDs

Special DME Review Considerations

Items and Services Having Special DME Review

PDAC - Applications and forms

PDAC - Applications and forms

CONTACT PDAC

CONTACT PDAC : 877-735-1326

Application for Code Review

Application for Code Review

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Ch. 20 Medicare Claims Processing Manual

MLN Fact Sheet

For ICD-10-CM, ICD10-PCS, CPT, and HCPCS Code Sets

Select the title to see a summary and a link to the full article.

HCPCS Codes Were NOT all Created for the Same Purpose

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Have you ever wondered why you were unable to find a particular product/code with our DMEPOS search? When looking for HCPCS Level II codes, there are several kinds of codes and not all HCPCS codes were created for the same purpose. If you are searching for a certain HCPCS product ...

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Healthcare Common Procedure Coding System (HCPCS)

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There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...

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When Can You Bill Orthosis Components Separately?

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Othoses often have extra components. When can you bill those components separately? For example, can you bill for a suspension sleeve (L2397) with a knee orthosis (e.g., L1810)?

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Electrical Stimulation and Electromagnetic Therapy Devices

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Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint.

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Home Oxygen Therapy

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Home Oxygen Therapy Guidelines

Read the article →

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Access to this feature is available in the following products:
  • HCC Plus
  • Find-A-Code Professional
  • Find-A-Code Facility Base


Select the webinar title to view a summary and link to the webinar video.

Proper Coding and Billing for Drugs, Biologicals and Injections

Proper Coding and Billing for Drugs, Biologicals and Injections

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Medicare Resources


Select the podcast title to view a summary and link to the podcast.

Do You Have All the Right Dental Resources Needed to Succeed in Dental Medical Billing and Coding?

Discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success). Some of the resources and tools they discuss will help you with your dental coding/billing and education.

Listen to the podcast →


Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426):
Effective 01/01/2018, Durable Medical Equipment Medicare Administrative Contracts (DME MACs) have created standardized language to assist Durrable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers in understanding the information necessary to justify payment.

**Important**

The information in this document supersedes the material currently contained in all LCDs and related policy articles. Where there are differences between the policies and this article, this document shall take precedence.


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