What are durable medical equipment (DME) codes?
These codes represent all of the supplies or equipment that used in the patient's care. All Durable Medical Equipment is classified under HCPCS Level II. As such, these are the only codes you will use as a DME biller or coder. Durable medical equipment billing specialists generally focus on the larger durable medical equipment:
Does Medicare cover durable medical equipment?
Medicare only covers DME if you get it from a supplier enrolled in Medicare. This means that the supplier has been approved by Medicare and has a Medicare supplier number. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program
What is the durable medical equipment billing process?
Another important part of the durable medical equipment billing process is the complex nature of reimbursement. Because some of the equipment is rented rather than purchased, DME billers and coders must know exactly how to code claims and when to send them, in order to get the right reimbursement amounts.
Why outsource DME billing and coding?
Due to the complex nature of the durable medical equipment billing and coding process, many hospitals and clinics outsource to specialty DME billing companies. These companies are experienced and educated in the DME billing process, and make sure the correct and timely filing of DME claims.
What are the DME codes?
DME procedure codes with most claims in 2020E0601. Continuous positive airway pressure (CPAP) Device. ... E0114. Crutches underarm, other than wood, adjustable or fixed pair, with pads, tips and handgrips. ... E0562. Humidifier, heated, used with positive airway pressure (PAP) device. ... E0700. ... E1390. ... E1399. ... E0570. ... E0776.More items...
What is the ICD 10 code for durable medical equipment?
Claims for DME for a disabled parent must be submitted using HCPCS code A9999 (miscellaneous DME supply or accessory, not otherwise specified), ICD-10-CM diagnosis code Z73. 6 and modifier SC.
What is required when billing Medicare for repair of previously purchased equipment?
With respect to Medicare reimbursement for the repair, there are two documentation requirements: Treating physician/practitioner must document that the item being repaired continues to be reasonable and necessary. Treating physician or supplier must document that the repair itself is reasonable and necessary.
Which Medicare Part provides coverage for durable medical equipment?
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.
What is DME in medical billing?
Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses.
What is the purchase modifier for DME?
ModifiersModifierBrief DescriptionMod KHDMEPOS item, initial claim, purchase or first month rentalMod KIDMEPOS item, second or third month rentalMod KJDMEPOS item, parenteral enteral nutrition (PEN) pump or capped rental, months four to fifteenMod KKDMEPOS item subject to Competitive Bidding Program II108 more rows
How do you code DME?
Effective for claims with dates of service from February 28, 2022 through March 31, 2022, suppliers should use HCPCS code E1399 (Durable medical equipment, miscellaneous) to submit claims for adjunctive CGM receivers and HCPCS code A9999 (Miscellaneous DME supply or accessory, not otherwise specified) to submit claims ...
What is the RB modifier used for?
In contrast, the RB modifier is used on a DMEPOS claim to denote the replacement of a part of a DMEPOS item (base equipment/device) furnished as part of the service of repairing the DMEPOS item (base equipment/device).
Does DME need a modifier?
In addition to an appropriate HCPCS code for the DME item, many HCPCS codes require a modifier. The modifiers are used to provide more information about the item.
Is DME covered by Medicare Part B?
DME is reusable medical equipment, like walkers, wheelchairs, or hospital beds. If I have Medicare, can I get DME? Anyone who has Medicare Part B (Medical Insurance) can get DME as long as the equipment is medically necessary.
What is Medicare Part C called?
A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare.
Which Medicare Part provides coverage for durable medical equipment quizlet?
DME is covered as the same as Medicare Part B.
What is gap filling in Medicare?
For newly covered items of DMEPOS paid on a fee schedule basis where a Medicare fee does not exist , the Centers for Medicare & Medicaid Services (CMS) uses a process to establish fees called gap-filling. This allows Medicare to establish a price that aligns with the statutory requirements for the DMEPOS fee schedule.
When will Medicare change the KU modifier?
As aforementioned, these system changes will be implemented on July 1, 2020.
What is Medicare Accessibility Act?
CMS is implementing the Patient Access and Medicare Protection Act to ensure that beneficiaries have access to wheelchair accessories and seat and back cushions when furnished with Group 3 complex rehabilitative power wheelchairs. To ensure beneficiary access to these accessories particularly for these vulnerable populations, advance payment may be available for suppliers. Prior to July 1, suppliers will be paid the adjusted fee schedule rates. The average reduction during this period for these items is approximately 10%. During this time, CMS has announced that suppliers are able to submit a single advance payment request for multiple claims if the conditions described in CMS regulations at 42 CFR Section 421.214 are met. Additional information is below.
What is a DMEPOS file?
The DMEPOS public use file contains fee schedules for certain items that were adjusted based on information from the DMEPOS Competitive Bidding Program in accordance with Section 1834 (a) (1) (F) of the Act.
What is TTFT in Medicare?
TTFT is a system consisting of an electromagnetic field generator and transducer arrays and will be covered under the Medicare Part B benefit for durable medical equipment (DME) for items and services furnished on or after September 1, 2019.
What is a CGM?
CGMs are items of durable medical equipment (DME) that provide critical information on blood glucose levels to help patients with diabetes manage their disease . In January 2017, CMS issued a ruling providing for Medicare coverage of therapeutic CGMs.
When will CMS reprocess claims?
Claims for these accessories submitted prior to July 1, 2020, with dates of service from January 1, 2020 through June 30, 2020, will need to be reprocessed to ensure that CMS pays the unadjusted fee schedule amounts, as required by section 106 of the Further Consolidated Appropriations Act, 2020.
Why is durable medical equipment billing important?
Another important part of the durable medical equipment billing process is the complex nature of reimbursement. Because some of the equipment is rented rather than purchased, DME billers and coders must know exactly how to code claims and when to send them, in order to get the right reimbursement amount s.
What is durable medical equipment?
Durable medical equipment must be prescribed by a medical doctor, found medically necessary, and then approved by the patient's insurance company. Only then can the equipment be distributed to the patient. Because of this, the durable medical equipment billing and coding process is much more complicated than normal billing and coding.
What is a HCPCS code?
HCPCS codes are technically HCPCS Level II codes. They include both numbers and letters and are also 5 digits long. These codes represent all of the supplies or equipment that used in the patient's care. All Durable Medical Equipment is classified under HCPCS Level II.
Who must see a patient?
The patient must be seen by a doctor, who finds that some sort of durable medical equipment is medically necessary for the patient's care, or due to the patient's diagnosis. For example, a child presents to a pediatrics practice with croup (inflammation of the airways).
What does DME mean in medical terms?
DME means Durable Medical Equipment. Medical equipment’s that are utilized by the provider in treatment of the procedure or it’s prescribed by the provider to the patient, which is appropriate to use in the home and helps to boost patient’s daily activities. It means DME is principally used to help in for a medical purpose, ...
Does DME require a prescription?
DME requires a prescription to either rent or purchase the equipment. Authorization is required from insurances for a few of the Durable Medical Equipment’s and it varies from insurance to insurance. Medicare insurance as secondary won’t pay for the rental items. It means Medicare insurance as secondary they pay just for the purchased items.
What is assignment in Medicare?
Assignment —An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
Does Medicare pay for DME repairs?
Medicare will pay 80% of the Medicare-approved amount (up to the cost of replacing the item) for repairs. You pay the other 20%. Your costs may be higher if the supplier doesn’t accept assignment.
Description Information
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
National Coverage Analyses (NCAs)
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.
Is wheelchair accessory reimbursable?
There are select wheelchair accessories that are not separately payable when billed in the same month of service as manual, motorized, or power wheelchair bases by any provider. There are select equipment procedure codes that are not separately reimbursable when billed with supply procedure codes by any provider.
Do you need an invoice to bill a claim?
When you bill with a listed code (a code with a price on file): An invoice or catalog is not required with your claim. The claim does not require manual pricing. The claim can be billed electronically.