2012 DMEPOS Jurisdiction List Updated

The spreadsheet containing HCPCS Level II codes for durable medical equipment Medicare administrative contractor (DME MAC), Part B carrier, or A/B MAC jurisdictions has been updated for 2012 to reflect supply codes that have been added or discontinued.

As part of the 2012 update, the following HCPCS Level II codes are affected:

L8511 Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each
L8512 Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10
L8513 Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each
L8514 Tracheoesophageal puncture dilator, replacement only, each
L8515 Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each

These voice prosthesis codes are changing claims processing jurisdiction from DME MAC to joint local carrier and DME MAC jurisdiction if used with tracheoesophageal voice prostheses inserted by a licensed health care provider. Otherwise, continue to submit claims for these codes to the appropriate DME MAC.

Carriers and A/B MACs will manually price claims for these codes with dates of service on or after Jan. 1, 2012 using the 2012 durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) fee schedule, found in Attachment B of Change Request (CR) 7679.

Billing staffs should refer to this spreadsheet to ensure the appropriate Medicare contractor is being billed for HCPCS Level II codes that appear in the list.

Source: MLN Matters® article MM7679, issued March 23, 2012


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