DMEPOS Competitive Bidding: Exceptions to Every Rule

A new fact sheet posted Oct. 22 on the Centers for Medicare & Medicaid Services (CMS) MLN General Information website provides helpful information for physicians and other practioners who provide items to Medicare patients who are affected by the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.

The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: Physicians and Other Treating Practitioners Who Are Enrolled as Medicare DMEPOS Suppliers Fact Sheet explains how, under the DMEPOS Competitive Bidding Program, patients with Original Medicare in designated competitive bidding areas (CBAs) are required to obtain certain DMEPOS from a contract supplier, unless an exception applies. Understanding the exceptions to the rule is important for physicians and other practitioners who are enrolled as DMEPOS suppliers.

For the first phase of competitive bidding, effective Jan. 1, 2011, one of these exceptions allows Medicare physicians and treating practitioners (including podiatric physicians, nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNS)) who also have enrolled as Medicare DMEPOS suppliers via the CMS-855S enrollment form to furnish competitively bid walkers in a CBA to their own patients without submitting a bid and being selected as a contract supplier.

To qualify for this exception, the following requirements must be met:

  • The walker must be furnished by the physician’s or treating practitioner’s DMEPOS supplier.
  • The walker must be billed to a DME Medicare administrative contractor (DME MAC) using the DMEPOS billing number assigned to the provider or group practice.

Medicare pays the single payment amount established by the Competitive Bidding Program for walkers furnished under this exception, and the provider must accept assignment.

To be paid for walkers as a non-contract supplier, physicians and treating practitioners should use modifier KV DMEPOS item subject to Competitive Bidding Program in combination with the appropriate HCPCS Level II code. On the claim billed to the DME MAC, the walker line item must have the same service date as the professional service office visit billed to the Part A/B MAC. Providers are advised to submit the office visit and walker claims on the same day.

Visit the CMS dedicated website for more information about the DMEPOS Competitive Bidding Program, including a list of the first nine CBAs and DMEPOS items included in the program.

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