dme billing

  1. Y

    Wiki DME Billing

    My providers office is just starting out on DME for our patients. It has been difficult to find beginner level information on this topic. I think I've got most of it figured out except the very first step. Does our provider office bill for the DME or does the supplier? I know we need...
  2. sempson

    Wiki How to bill out on CMS 1500 DME?

    Hello, How do you bill out on the CMS 1500 a knee brace? I entered L1820 and the Medicare EOB stated "you must send the claim to the correct payer/contractor. Claim not payable under jurisdiction area." I called Medicare and they will not help me with this denial. They said to call the Medicare...
    • sempson
    • Thread
    • dme dme billing
    • Replies: 3
    • Forum: ICD-10
  3. K

    Wiki A4595 vs A4556/A4558

    Hello, DME supplies billed with A4556 & A4558 for a multi-functional electrical stimulation device that is NOT a TENS unit (billed and paid under HCPC code E0770/E1399). Some carriers are requesting for code A4595 to be billed instead. Does anyone know why some carriers are requesting this...
    • Kenia562
    • Thread
    • a4556 a4558 a4595 dme billing dme supplies e0770 e1399 electrodes h-wave multi-functional electrical stimulator
    • Replies: 0
    • Forum: Billing/Reimbursement
  4. S

    Wiki CO-B15 Denial for DME

    We have received numerous denials for CO B15 for DME claims. The appeal returned the explanation that the ordering provider was not permitted to order the DME items. The Physician is PECOS enrolled and the orders he writes for DME providers are denied in Jurisdiction D only. Other...
  5. R

    Wiki Detailed Written Orders

    Hello. I have provider who submitted a Letter of Medical Necessity for a 2018 medical record review and wants to count this as there Standard Written Order or Detailed Written Order. I was told a separate order was needed for this review for DME (L0648) specifically. Can anyone give any...
  6. J

    Wiki DME Modifier

    Anyone familiar with a modifier to use with DME HCPC's that signifies that patient opted to pay out of pocket for an upgrade on a piece of medically necessary equipment? I want to bill for the medically necessary item but also report to payers when a patient chooses the add-on's.
    • JodiMott
    • Thread
    • dme billing modifier upgrade
    • Replies: 2
    • Forum: Modifiers
  7. N

    Wiki DME claim split for BCBS & UHC

    Is it common practice or required to split DME for BCBS/UHC commerical plans to a separate claim when billed with other services ex: 99213 and/or surgical procedures because the Place of service is different? I know it has to be split off when it is a Medicare patient to bill to DMERC, but I am...
  8. D

    Wiki DME Coding/Reimbursement - A7020

    Hello! Anyone with experience billing A7020 to Medicare for mechanical in-exsufflation devices ... the LCD is quite vague regarding accessories/supplies, but I am wondering if anyone has experienced difficulties/limitations billing A7020 for replacement circuits? If anyone with a DME-specialty...
  9. G

    Wiki DME Billing to Medicare-HELP!!!!!!

    Hi! I'm getting continuous rejections from Medicare for DME products. For example, I've billied L4361(Walking Boot) with and without mod NU, RT/LT and without a modifier but Medicare denies the claim saying "procedure code is inconsistent with modifier used or a required modifier is missing". I...
  10. L

    Wiki Home Health and DME

    We are having an issue for providers who do wound care. They see a patient, debride the wound, order collagen and other wound care items to be sent to the patients home so they can change their dressing in between debridements. Unbeknownst to us, the patient is seen by a Home Health nurse and...
  11. A

    Wiki Billing for shoes and inserts to Medicare (ING)

    Hi everyone! I am trying to bill to CGS Medicare for DME. The doc did 1 pair of shoes A5500 and 3 pairs of inserts A5512 for a diabetic patient. I am new to DME billing and I heard so many different versions how I supposed to do it. Previously I billed A5500 x 1 and A5512 x 3 and haven't heard...
  12. S

    Wiki DME- Second garment (E0731) for kneehab unit- MEDICARE HELP PLEASE

    I need assistance with billing for a second garment for use with the kneehab unit (E0745). :confused: Previously, Medicare had covered bi-lateral garments, since they can not be used interchangeably. They have stopped paying for the second garment within a 12 months period stating it is not...
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