The Centers for Medicare and Medicaid Services (CMS) is responsible for the release of the Durable Medical Equipment Prosthetics, Orthotics, and Supplies Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List. The notification is sent to the DME Medicare Administrative Contractor (MAC) and the Part B local carrier/Part B MAC annually. The list contains any added or discontinued codes for the current year. The chart described in the Change Request below will allow you to determine whether claims are submitted to your local carrier/B MAC or to your Durable Medical Equipment MAC (DME MAC).
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items provided to Hospice patients are eligible for coverage by the DME MAC only when those items or supplies are provided to the patient for treatment of a condition or illness not related to the patient’s terminal illness. During any period when the beneficiary’s Hospice coverage is elected, all rights to Medicare Part B payment are waived for services related to the treatment and management of the beneficiary’s terminal illness.
The oral drugs must be administered or prescribed by a physician and all claims for Medicare covered services and items that are a result of a physician’s order or referral must include the ordering or referring physician’s name and National Provider Identifier (NPI).
Please note: Physicians should be aware that a service which is listed as “billable to the carrier if incident to a physician’s service” does not guarantee coverage. Many items that are “incident to a physician’s service” are considered bundled services and are not separately billable or payable.
Submit claims for Durable Medical Equipment to:
Durable Medical Equipment Medicare Administrative Contractor (DME MAC)
PO Box 20010
Nashville, TN 37202
Toll-free: 1-866-270-4909 (Jurisdiction C)
Hearing Impaired: 1-888-204-3771
Hours: 8:00 a.m.-4:30 p.m. CST
Web site: http://www.cgsmedicare.com/jc/
Physician’s Corner: http://www.cgsmedicare.com/jc/mr/phys_corner.html