Dmepos Claims Are Submitted To

Question: Durable medical equipment (DME)

Answer: Defined by Medicare as equipment that can withstand repeated use, is primarily used to serve a medical purpose, is used in the patient's home, and would not be used in the absence of illness or injury.

Question: Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)

Answer: Include artificial limbs, braces, medications, surgical dressings, and wheelchairs.

Question: Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) dealers

Answer: Supply patients with DME. DMEPOS claims are submitted to DME Medicare administrative contractors (DME MACs) that replace durable medical equipment regional carriers (or DMERCs) that are awarded contracts by CMS. Each DME MAC covers a specific geographic region of the country and is responsible for processing DMEPOS claims for its specific region.

Question: Permanent national codes

Answer: Are maintained by the HCPCS National Panel which is composed of representatives from the Blue Cross/Blue Shield Association (BCBSA), the health Insurance Association of America (HIAA) and CMS. They are responsible for making additions, revisions and deletions.to the national alphanumeric codes.

Question: Medicare pricing, data analysis and coding (PDAC) contractor

Answer: Responsible for providing suppliers and manufacturers with assistance in determining HCPCS codes to be used.

Question: Miscellaneous codes

Answer: include miscellaneous /not otherwise classified codes that are reported when a DMEPOS dealer submits a claim for a product or service for which there is no existing HCPCS level II code.

Question: Temporary codes

Answer: are maintained by the CMS and other members of the HCPCS National Panel, independent of permanent HCPCS level II codes. Temporary codes allow payers the flexibility to establish codes that are needed before the next January 1 annual update. Temporary codes also serve the purpose of meeting short-time-frame operational needs of a particular payer.

Question: Transitional pass-through payments

Answer: Temporary additional payment(s) (above the OPPS reimbursement rate) made for certain innovative medical devices, drugs, and biologicals provided to Medicare beneficiaries.

Question: Modifiers

Answer: Indicated the description of the service or procedure performed has been altered. HCPCS modifiers are reported as two-character alphabetic or alphanumeric codes.

Question: Orthotics

Answer: The branch of medicine that deals with the design and fitting of orthopedic (relating to bone disorders) devices.

Question: Prosthetics

Answer: The branch of medicine that seals with the design, production, and use of artificial body parts.

Question: Certificate of medical necessity

Answer: Form to be completed and signed by the prescriber for insurance payment.