By Kim Turner
In a change release (CR) dated 12/20/2019 regarding MLN Matters MM11554, CMS published the following information on where to bill DMEPOS and PEN services.
Effective date March 23, 2020, suppliers enrolled with the National Supplier Clearinghouse (NSC) as a DMEPOS supplier should enroll with and bill to the A/B MAC Part B for replacement parts, accessories, and supplies for prosthetic implants and surgically implanted DME items. Suppliers should bill to A/B MAC Part B if those items are not billable to the A/B MAC Part A as identified in the bulleted list below:
- Skilled Nursing Facilities (SNFs), Comprehensive
Outpatient Rehabilitation Facilities (CORFs), Outpatient Physical Therapy
(OPT), and hospitals bill the A/B MAC Part A for prosthetic/orthotic devices,
supplies, and covered outpatient DME and oxygen
- Home Health Agencies (HHAs) should bill DME to the A/B MAC (Home Health & Hospice (HHH)) or should meet the requirements of a DME supplier and bill the DME MAC. This is the HHA's decision. A/B MACs Part A other than A/B MACs (HHH) will receive claims only for the class, “Prosthetic and Orthotic Devices.”
- Unless billing to the A/B MAC Part A is required as outlined in the preceding bullet, submit claims for implanted DME, implanted prosthetic devices, replacement parts, accessories, and supplies for the implanted DME to the A/B MACs Part B and not the DME MAC.
- Suppliers that enroll with the NSC as a DMEPOS supplier should bill the A/B MAC Part B using their National Provider Identifier (NPI) and should not include their NSC number on the claim.
- Under no circumstances should any entity enrolled as a DMEPOS supplier with the NSC bill the A/B MAC Part B for an implanted device unless you are the physician or provider that implants the device. However, DMEPOS suppliers should bill for any of the replacement parts, accessories, or supplies for prosthetic implants and surgically implanted DME.
- The supplier’s location determines the claims filing jurisdiction for DMEPOS in accordance with Chapter 1, Section 10 of the Medicare Claims Processing Manual. With respect to payment for DMEPOS, contractors take note of the longstanding policy for payment of DMEPOS, which specifies that payment for DMEPOS is based on the fee schedule amount for the State where the beneficiary maintains his/her permanent residence.
Such suppliers should bill the A/B MAC Part B for the items above only, unless the entity separately qualified as a supplier for items and/or services in another benefit category.
Have questions about billing services to A/B MAC Part B? Contact The van Halem Group for assistance.