Health Information Management

Q/A: Billing for DME

APCs Insider, May 22, 2009

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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 Supplies
 
When 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.



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