Neurology & Pain Management Coding Alert

Question: It is my understanding that durable medical equipment (DME) codes beginning with E or L must be billed by a DME provider. Can all other HCPCS codes be billed by a neurologist?

Colorado Subscriber

Answer: For the most part, yes. If you review the guidelines at the beginning of each section, (e.g., A, B, C, etc.), the Medicode version of HCPCS states which codes are billable to the DMERC (durable medical equipment regional carrier). Specifically, it states, Medicare claims for E codes fall under the jurisdiction of the DME regional carrier, unless otherwise noted. Similarly, claims in section A (transportation services) fall under the jurisdiction of the local carrier. The HCPCS guide also contains special notations for codes subject to carrier discretion, and those not covered by Medicare. There are some codes in sections E and L that may be billable by physicians offices, but such rules vary between the four DMERC carriers. Contact your carrier or review their policies before billing any HCPCS codes you are not familiar with. To obtain links to regional carriers, please see www.codinginstitute/news/article3.