Q/A: Billing for DME
APCs Insider, May 22, 2009
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Q: What if your hospital doesn’t have a DME license? Do you still use only the L codes?
A: A hospital is not required to possess a DME license in order to bill orthotics & prosthetics (L codes) or take home surgical dressings (A codes). These items are billed with the appropriate HCPCS code using revenue code 0274 and 0623, respectively. These items are billed on the hospital UB04 under the regular hospital provider number, as are other OPPS services. The FI/MAC utilizes the DMEPOS fee schedule in order to apply payment amounts for these items. This is what is meant by the parenthetical note in the April OPPS update in CR6416 shown below.
Further Clarification Related to Billing for Medical and Surgical SuppliesWhen medical and surgical supplies (other than prosthetic and orthotic devices as described in the Medicare Benefit Policy Manual, Pub. 100-02, Chapter 15, §120 and §130, and take-home surgical dressings) described by HCPCS codes with status indicators other than "H" or "N," are provided incident to a physician's service by a hospital outpatient department, the HCPCS codes for these items should not be reported because these items represent supplies.
Remember that the L codes, for the majority, include the fitting and adjustment. Therefore you should not report 29XXX in addition to L codes.
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Related Products
Most Popular
- Articles
-
- CMS seeks comment on quality measures
- Practice the six rights of medication administration
- Don't forget the three checks in medication administration
- Nursing responsibilities for managing pain
- Note similarities and differences between HCPCS, CPT® codes
- The consequences of an incomplete medical record
- Q&A: Primary, principal, and secondary diagnoses
- ICD-10-CM coma, stroke codes require more specific documentation
- Neurological checks for head injuries
- OB services: Coding inside and outside of the package
- E-mailed
- Searched