DME or DMERC billing process

BIPAP Devices


Use OPAS or submit form FH-1A to request continued services for BIPAP devices no sooner than 61 days and no later than 120 days after initiation of therapy. Form FH-1A or an attached physician ’ s note must contain a signed and dated statement declaring that the recipient is:

* Compliantly using the device an average of 4 hours per 24 hour period;
* and Benefiting from its use


Diabetic Supplies


Diabetic supplies are billed through the pharmacy program (provider type 28), not DME provider type 33.

The exceptions to this are as follows: insulin pumps (E0784) and insulin pump-related supplies (A4223, A4230, A4231 and K0552) or diabetic shoes/fittings/modifications (A5500 – A5513) which need to be
billed through DME.

CPAP Devices


Use OPAS or submit form FH-1A to request continued services for CPAP devices no sooner than 61 days and no later than 120 days after initiation of therapy. The request must include all of the following:

*The number of hours a day the machine is used;
* The number of months the recipient has used the machine;
* Whether the recipient will continue to use the machine; and
* The name of the person who answered these questions (it can not be the DME supplier).

Power Mobility Devices (PMD)

Prescribing physician/practitioners may bill an additional fee using HCPCS code G0372 on the claim for the office visit (CPT 99211) during which the Medicare- required face-to-face examination/evaluation was completed.

Power Operated Vehicle (POV), Basic Equipment Package Upon initial issue, a POV must include all items below; separate billing/payment is not acceptable.

* Battery or batteries required for operation
* Battery charger, single mode
* Weight appropriate upholstery and seating system Tiller steering
* Non-expandable controller with proportional response to input
* Complete set of tires
* All accessories needed for safe operation

http://www.cms.hhs.gov/manuals/downloads/clm104c20.pdf



Payment


Medicare payment for durable medical equipment (DME), prosthetics and orthotics (P&O), parenteral and enteral nutrition (PEN), surgical dressings, and therapeutic shoes and inserts is equal to 80 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, less any unmet deductible. The beneficiary is responsible for 20 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, plus any unmet deductible.

Medicare fee schedule

More information

DME billing basics

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