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.

DMEPOS Items: Medical Record Documentation

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According to MLN Connects 2022-04-21 MLNC, "For Medicare to cover any Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item, the patient’s medical record must include enough documentation to justify the need for: Type and quantity of items ordered Frequency of use (or replacement if applicable) The medical record should include the patient’s ...

58% of Improper Payments due to Medical Necessity for Ventilators

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Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...

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Subscribers will see the tips about using this code for billing and reimbursement.Access to this feature is available in the following products:
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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


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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