Billing for Durable Medial Equipment (DME), Orthotic/Prosthetic

60 - Billing for Durable Medial Equipment (DME), Orthotic/Prosthetic Devices, and Supplies (including Surgical Dressings) (Rev. 3053, Issued: 08-28-14, Effective: ICD-10: Upon Implementation of ICD-10 ASC-X12: 01-01-12, Implementation ICD-10: Upon Implementation of ICD-10; ASC X12: 09-30-14) A SNF may not bill for DME furnished to its Part A inpatients as necessary DME must be supplied to the beneficiary as part of SNF services. A SNF may not bill for DME furnished to its Part B inpatients or outpatients. However, a SNF may qualify as a supplier and enroll with the National Supplier Clearinghouse. In such cases, the SNF is given a separate supplier number to bill outpatient DME to the DME MAC. The DME MAC will furnish billing guidelines and payment will be made directly to the SNF as a supplier. The SNF or other entity that furnishes prosthetic and/or orthotic devices to SNF residents for whom Part A benefits are not payable (no Part A entitlement or benefits exhausted) and for SNF outpatients may bill for such items. The SNF bills the A/B MAC (A). Suppliers bill the A/C MAC (B) or DME MAC. See Chapter 20 for DMEPOS billing requirements, including definition of "supplier." Prosthetic and orthotic devices are: • Prosthetic devices (other than dental) that replace all or part of an internal body organ (including connective tissue) or replace all or part of the function of a permanently inoperative or malfunctioning internal body organ, including replacement or repair of such devices (see the Medicare Benefit Policy Manual, Chapter 15, "Covered Medical and Other Health Service," §120); and • Leg, arm, and neck braces, trusses, and artificial legs, arms, and eyes, including adjustments, repairs, and replacement required because of breakage, wear, loss, or a change in the patient's physical condition (see the Medicare Benefit Policy Manual, Chapter 15, "Covered Medical and Other Health Service," §130). SNFs bill supplies to its A/B MAC (A) for outpatients.