Durable Medical Equipment (DME) Center
Spotlights
Revised Fact Sheet for Referral Agents - Where are the Round 2 areas? What if a beneficiary travels? What do you need to know before prescribing a DMEPOS item or referring the beneficiary to a DMEPOS supplier? Want more information on the national mail-order program for diabetic testing supplies?
For answers to these questions and more, see the revised “Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program: Referral Agents” Fact Sheet (ICN 900927), which is now available in downloadable format.
- Ordering and Referring Denial Edits Will Turn on May 1, 2013
Effective May 1, 2013, CMS will instruct contractors to turn on Phase 2 denial edits on the following claims to check for a valid individual National Provider Identifier (NPI) and to deny the claim when this information is missing- Medicare Part B claims including Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and
- Part A Home Health Agency (HHA) claims that require an attending physician provider.
For more information:
Attend the National Provider Call on March 20 from 3-4:30ET. Register Now.
- MLN Matters® Article #SE1305, "Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims"
- “Medicare Enrollment Guidelines for Ordering/Referring Providers”
- “The Basics of Medicare Enrollment for Physicians Who Infrequently Receive Medicare Reimbursement”
- Medicare DMEPOS Competitive Bidding single payment amounts for Round 2 and the national mail-order program for diabetic testing supplies have been announced. View Press Release and Fact Sheet
- The Centers for Medicare & Medicaid Services has furnished the list of 2012 HCPCS codes initially designated as Off-The-Shelf (OTS) orthotics. View the list of OTS Orthotics . (Posted 2/9/2012)
- Blood Clotting Factor Furnishing Fee
Medicare FFS e-News Spotlights
- Subscribe now to receive the weekly CMS Medicare FFS Provider e-News for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
Important Links
Billing / Payment
Payment
Enrollment / Participation
- Medicare Provider-Supplier Enrollment
- - which suppliers accept assignment for DMEPOS by state
Medicare Prescription Drug Coverage
- Information for Providers
Policies & Regulations
- Quarterly Provider Updates
- Medicare Program; Payment for Respiratory Assist Devices With Bi-Level Capability and a Backup Rate (CMS-1167-F) [PDF, 85KB] and (published in the Federal Register on January 27, 2006)
Medicare Secondary Payer
- Medicare Secondary Payer & You
- 100-05 Medicare Secondary Payer Manual
- Coordination of Benefits - General Information
DME Medicare Administrative Contractor (MAC) Websites
Contacts
- DME MAC Contacts [PDF, 14KB]
- SADMERC Helpline: (877) 735-1326 --- Who you should contact to determine which HCPCS code to use for billing
- CMS Regional Offices
- Contacting the COB Contractor
Competitive Bidding
CMS Manuals & Transmittals
- Manuals
- Internet-Only Manuals (IOMs)
- DMEPOS Transmittals
- CMS Program Memoranda
- Chapter 15 – Covered Medical and Other Health Services [PDF, 1MB] (Chapter 15, Section 110)
- Chapter 20 - Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) [PDF, 443KB] (Medicare Claims Processing Manual)
- To receive changes to the CMS Quarterly Provider Update, subscribe to the CMS-QPU listserv from the CMS Mailing Lists.
- National Coverage Determinations (NCD) Manual - Pub. 100-03
DME MAC Supplier Manuals
National Provider Identifier (NPI)
Coding
- HCPCS - General Information (HCPCS)
- DMEPOS_Jurisidiction_List [ZIP, 37KB] -- A spreadsheet containing an updated list of the HCPCS for Durable Medical Equipment Regional Carrier (DMERC) and Part B local carrier jurisdictions is updated annually to reflect codes that have been added or discontinued (deleted) each year. Changes in section 20.3, Publication 100-04 of the Claims Processing Manual are reflected in the recurring update notification.
- Alpha-Numeric HCPCS
- ICD-9-CM
- ICD-10
Program Integrity/ Medical Review
- Chapter 5 - Items and Services Having Special DME Review Considerations [PDF, 250KB] - Program Integrity Manual - Items and Services Having Special DMERC Review Considerations
- Chapter 12 - The Comprehensive Error Rate Testing Program [PDF, 87KB] - Program Integrity Manual - FI, Carrier, DMERC and RHHI Interaction and Coordination with Program Safeguard Contractors (PSCs)
Fraud & Abuse
- Beneficiary Complaint Response Program
Education
How to Stay Informed
Subscribe now to receive the weekly CMS Medicare FFS Provider e-News for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- Home Health, Hospice & Durable Medical Equipment Open Door Forum
