DMEPOS Payments for Inpatient Stays

These facility types must directly provide DMEPOS items and services during an inpatient stay or arrange for a supplier to provide them:

• Acute care hospitals (ACHs)
• Long-term care hospitals (LTCHs)
• Inpatient rehabilitation facilities (IRFs)
• Inpatient psychiatric facilities (IPFs)
• Critical access hospitals (CAHs)

We include all DMEPOS items and services provided during a Medicare Part A-covered stay in the Inpatient Prospective Payment System (IPPS) rate. The facility includes those supplier items on its Medicare inpatient claims, and we don’t make separate payments for items provided during an inpatient stay.

Providers and suppliers shouldn’t bill Medicare for DMEPOS items and services when Medicare patients are in a facility. These are improper claims.

We don’t pay you for items provided during an inpatient stay. You should refund patients any incorrectly collected deductible or coinsurance amounts. The inpatient facility directly pays you for the items provided.

Section 1861(n) of the Social Security Act limits Medicare Part B DME coverage to items and services used in the patient’s home. As described in 42 CFR 410.38, we don’t pay separately for DME provided to patients for use in hospitals, CAHs, or skilled nursing facilities because these facilities aren’t qualified homes. The facility must provide all medically necessary DMEPOS items and services during a Part A-covered stay.

In some cases, you may deliver certain DMEPOS items before a patient is discharged from a facility that isn’t considered their home. These items may include prosthetics or orthotics but not supplies. We allow pre-discharge delivery and training when all these conditions are met:

Item Conditions

The item is medically necessary:

• For the patient to use in their home
• On the patient’s discharge date

Supplier Conditions

• You deliver the item:
  • Only for training or fitting, and the patient uses it in their home after discharge
  • No earlier than 2 days before discharge
• You don’t:
  • Bill any item before the discharge date
  • Bill additional delivery costs (for example, redelivery) to us or the patient
• Your reason for providing the item isn’t to eliminate the inpatient facility’s responsibility to provide the medically necessary item
• You pick up the item at the facility and deliver it to the patient’s home on the date of discharge (if the patient didn’t take the item home)

Patient Conditions

The patient:

• Takes the item home (or, if the patient forgot the item, the supplier delivers it on the discharge date)
• Is discharged to a qualified place of service and not another facility that’s not their home

Medicare Claims Processing Manual, Chapter 20, sections 110.3.1–110.3.3 describe scenarios for pre-discharge DMEPOS delivery and facility responsibilities during the transition from inpatient to home care.

Part B makes monthly payments for certain capped rental DME items like wheelchairs and hospital beds for a period of continuous use not to exceed 13 months.

Continuous use means the patient continues to have a medical need for the equipment and continues to use it, regardless of whether they’re at home or in the hospital. If a patient is admitted to a hospital or other facility that’s not a qualified home while they’re in a period of continuous use, this period and the monthly payments may be interrupted or end, depending on how long the patient is in the facility and whether their medical need for the equipment continues.

When you supply capped rental DME items used in the patient’s home, you:

• Can pick up the equipment while the patient is in the facility
• Must redeliver the equipment once the patient leaves the facility and returns home if the 13-month period of continuous use didn’t end while the patient was in the facility

When you supply oxygen and oxygen equipment used in the patient’s home, you:

• Can pick up the equipment while the patient is in the facility
• Must provide the equipment for use in the home again if the patient leaves the facility and returns home at any time during the 5-year reasonable useful lifetime of the oxygen equipment, regardless of how many times the patient enters a facility during the 5-year period

Interruptions in Use—Less Than 60 Days

If the patient’s medical need and use of the equipment is interrupted while they’re in the hospital or other facility that isn’t a qualified home, and the interruption is less than 60 consecutive days plus the days remaining in the last paid rental month, the period of continuous use is also interrupted but doesn’t end.

For example, if you got payment for the 10th month of continuous use before the patient was admitted to the facility, after they leave the facility and start using the equipment again in their home, the next payment you get is for the 11th month of continuous use.

Interruptions in Use of Capped Rental DME—More Than 60 Days

If the patient’s medical need for the capped rental DME ends while they’re in the facility and the break in need continues for more than 60 consecutive days plus the days remaining in the last paid rental month, the period of continuous use ends.

You aren’t required to provide the equipment for use in the home again once the patient leaves the facility, even if you provided it before they entered the facility.

Any supplier can provide the equipment for use in the home once the patient returns home from the facility, and a new 13-month period of continuous use can start.

You must submit:

• A new prescription
• New medical necessity documentation
• A statement describing why the equipment was medically unnecessary while the patient was in the facility

If you don’t submit this documentation, a new 13-month period of continuous use and rental payments won’t start.

Medicare Claims Processing Manual, Chapter 20, section 30.5.4 describes payment for capped rental items during the continuous use period.

No Interruptions in Use

If the patient’s medical need and use of the equipment continues while they’re in the hospital or other facility that isn’t a qualified home, monthly Part B payments for the equipment stop while they’re in the facility but there’s no break in the period of continuous use. Once the patient returns home, the monthly rental payments continue where they left off on the day the patient entered the facility, regardless of how long they were there.

For example, if you got payment for the 10th month of continuous use before the patient was admitted to the facility, after they leave the facility and start using the equipment again in their home, the next payment you get is for the 11th month of continuous use.

Part B makes monthly payments for oxygen and oxygen equipment for a period of continuous use not to exceed 36 months.

If the patient’s medical need for the oxygen and oxygen equipment ends while they’re in the facility and the break in need continues for more than 60 consecutive days plus the days remaining in the last month where payment was made, the period of continuous use ends if less than 36 continuous monthly payments were made.

You aren’t required to provide oxygen equipment for use in the home again once the patient leaves the facility, even if you provided it before they entered the facility.

Once the patient returns home from the facility, any supplier can provide oxygen equipment for use in the home and a new 36-month period of continuous use can start.

You must submit:

• A new prescription
• New medical necessity documentation
• A statement describing why the oxygen and oxygen equipment was medically unnecessary while the patient was in the facility

If you don’t submit this documentation, a new 36-month period of continuous use and rental payments won’t start.

Find your Medicare Administrative Contractor’s website for additional questions about billing for inpatient DMEPOS items.