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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

HCPCS - DME, Drugs, and Services Articles

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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

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Billing Exercise Equipment

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While equipment for home strengthening is arguably good for the patient and the prognosis of their condition(s), payers have very strict guidelines as to what is considered medically necessary when it comes to Durable Medical Equipment (DME). While I have seen some workers compensation policies which do pay for DME ...

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Medi-Cal Coverage Criteria for Hospital Beds and Accessories

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Medi-Cal coverage of child and adult hospital beds and accessaries. What is covered and what documentation is required.

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Capped Rental Items

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CMS Gives guidance on Capped Rental Items: Items in this category are paid on a monthly rental basis not to exceed a period of continuous use of 13 months. Based on Supplier Standard 5, suppliers are required to advise beneficiaries of the rent/purchase option for capped rentals and inexpensive or routinely purchased items. ...

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Home Oxygen Therapy -- CMN for Oxygen

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The Certificate of Medical Necessity (CMN) for Oxygen is a required form that helps to document the medical necessity for oxygen therapy. It also documents other coverage criteria for the oxygen use. For payment on a home oxygen claim, the information in the supplier’s records or the patient’s medical record must be substantiated with the information in the CMN.

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Preventive Medicine: Breastfeeding Supplies

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Preventive Medicine Topics Page Breastfeeding Supplies Procedure Codes A4286: Locking ring for breast pump, replacement E0602: Breast pump, manual, any type E0603: Breast pump, electric (ac and/or dc), any type E0604: Breast pump, hospital grade, electric (ac and / or dc), any type S9443: Lactation classes, non-physician provider, per session ICD-10-CM ...

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Documenting DMEs

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As per MLN MM8304,  This article is based on Change Request (CR) 8304, which instructs DME MACs to implement requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g). Due to concerns ...

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Coverage Criteria for Nonwearable Automatic Defibrillators

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According to Noridian and CGS Administrators LCD L33690, a nonwearable automatic defibrillator (E0617) is covered for beneficiaries in two circumstances. They meet either (1) both criteria A and B or (2) criteria C, described below: The beneficiary has one of the following conditions (1-8):A documented episode of cardiac arrest due to ventricular fibrillation, not due to a ...

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Home Oxygen Therapy -- A Face-to-Face Encounter

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What is required for a Home Oxygen Therapy, Face-to-Face Encounter.

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CMS Changes Definitions for Therapeutic Shoe Inserts

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CMS recently revised their definitions for custom fabricated and therapeutic inserts in order to meet current technology standards. Healthcare providers need to be sure to review the revisions in order to appropriately bill Medicare for inserts. For example, for custom fabricated, molded-to-patient, they have added the following: iii. For inserts used with ...

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HCPCS - DME, Drugs, and Services Webinars

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Proper Coding and Billing for Drugs, Biologicals and Injections

Proper Coding and Billing for Drugs, Biologicals and Injections

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HCPCS - DME, Drugs, and Services Resources/Links


Medicare Resources


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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