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Issue Number - Name
0019 - DME Billed While Inpatient
Review Type
Automated
Claim Type
DME Supplier
Region and State
RAC 5
All States
Date Approved
2017-02-01

Description

A supplier (includes physician furnishing DME) may deliver a DMEPOS item to a patient in a hospital or nursing facility for the purpose of fitting or training the patient in the proper use of the item. This may be done up to two (2) days prior to the patient's anticipated discharge to their home. The supplier should bill the date of service on the claim as the date of discharge and shall use the place of service (POS) as 12 (patient's home). The item must be for subsequent use in the patient's home. No billing may be made for the item on those days the patient was receiving training or fitting in the hospital or nursing facility.

Affected Codes

  • E0100-E8002, K0001-K0899, L0112-L4631, V2020-V2786, A4206-A9999, B4034-B9999 and J and Q codes

Applicable Policy References

  • Social Security Act, Volume 1, Title XVIII, Section 1834, Subsections (2)(B), (3)(A), (5)(A), (7)(A)(i)(1), (7)(C)(ii)(1)
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110
  • CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Sections 240.2, 240.2, 280.1, 280.2, 280.3, 280.6, and 280.7
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 20, Sections 10.2, 30.6, 100.2.2, and 110.3
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26.2
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.3