dme

  1. sempson

    Wiki HCPCS Code for massage device

    We are billing the VA for a back massager and they informed us we need a HCPCS code. I can not find a code for any back massager. Any help would be much appreciated.
  2. K

    Wiki DME Delivered at ASC/Outpatient Facility

    Hello! The CMS LCD pertaining to DME: Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426) only mentions delivery at an inpatient facility. Does anyone know how to bill a DME that was delivered to an ambulatory surgical center/outpatient facility? We dispense the...
  3. R

    Wiki L2114 AUDIT, HELP!!

    I recently appealed a RAC audit for code L2114 that was orginally denied stating "documentation did not support that the billed custom-fitted item required more than minimal self adjustment at the time of delivery in order to provide an individualized fit, and included a detailed description of...
  4. 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
  5. L

    Wiki Sleep Study Frequency

    I am looking for information regarding a new oral appliance for OSA. The procedure code is E0486. Pt has already had an appliance over 5+ years ago and is due for a new one. She has a new prescription from her PCP. The question is: Is there a timeframe on when the last diagnostic sleep study...
  6. N

    Wiki HCPCS L1851 - M17.11 supports alone for a Medicare JC audit?

    The LCD and article are stumping me in their verbiage for the medical necessity of the knee brace L1851. The LCD L33318 states: When I checked the group 4 ICD-10 codes, M17.11 (unilateral primary osteoarthritis, right knee) is listed in the LCD-related policy article, A52465. However, L33318...
  7. I

    Wiki Off the Shelf Back-Braces

    I was wondering, we buy the OTS braces in bulk from a wholesaler and keep them in the office to be dispensed whenever a patients needs it. Can we bill the L codes and the 97760? Since our providers are doing the assessment and we are also the suppliers? Please any advise would be greatly...
  8. C

    Wiki DME medicaid denials

    We have been receiving denials from our medicaid plans on our DME's such as L1902 and L3908, stating it is included in a global surgery package. We have never had this issue before. I have tried looking up changes to billing DME's but cannot find anything. I called the insurance and they can...
  9. J

    Wiki Walking boot for ankle sprain denied as "routine"?

    Hello, We gave a patient a Walking Boot with the sprained ankle diagnosis and UHC is denying this as "not covered when considered routine". I am attempting to appeal this but I'm not sure why this would be even considered routine on their part? Has anyone had experience with this? Thank you !
  10. L

    Wiki Billing Medicare DME outside of my jurisdiction.

    Hi all. I have a few Medicare recipients that are snow birds. My DME claims are getting denied because I am in JC and their policies are in JA. Medicare(CGS) told me to bill to that jurisdiction. I have tried to bill the jurisdiction they are in but get denied their as well. Any advice on...
  11. W

    Wiki DME Delivery Address Question

    Hello, I am wondering if there is CMS regulation regarding DME and the address it is delivered to, in accordance with the patient's health insurance. For example: A Back Brace is ordered for a patient and delivered to 15 Main St, Anywhere, USA, but according to the patient's insurance, their...
  12. D

    Wiki DME Coding/Reimbursement - A7020 and LCD L33795

    Hello! I'm looking for some insight from 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 or limitations billing A7020 for replacement...
  13. 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...
  14. M

    Wiki Billing DME

    I'm pretty new to using HCPCS level 2 codes. The code E0114 (crutches) has an indicator that says "Bill DME MAC" can anyone tell me what this means? Can I bill this to Medicaid?
  15. 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...
  16. N

    Wiki United Healthcare DME Supply Denials

    Our office is going crazy with these United Healthcare (Medicare Advantage Program) denials! I am hoping that someone else might be going through the same difficulty. We are a 3rd Party supplier/billing/coding company for DME supplies in nursing homes - generally when a patient finishes their...
  17. M

    Wiki General Ortho Surgery Charge Posting

    Hello all, I have recently made the move from a pediatrics office to a Pediatrics Orthopedics specialist and while I am familiar with office visits, post-op visits, xrays, & casting. I have NO experience with surgery charges and DME billing. Currently someone else is billing all of our...
  18. N

    Wiki DME - Suction Catheter non-published MUE

    We have a new developmental center coming onto our DME service (we are 3rd party supplier and biller). They have 4 patients using 12 suction cathether kits per day. The LCD has no specific information on covered amounts, simply that as long as there is a covered suction pump, you can supply and...
  19. O

    Wiki Durable Medical Supplies

    Our small clinic is looking to offer DME (splints, braces, crutches etc.) for our patients to walk out of the office with. Is it legal to bill different insurance carriers, different prices based on their reimbursement? Thanks you.
  20. D

    Wiki Billing DME to Medicare Without Medicare Contract

    After 26 years in working for physicians' offices, I started working for a DME business late last summer. We just became CHAP accredited and are filling out a Medicare Provider application. My question is - If we see a patient who has Medicare primary, can we bill Medicare DMERC (ie., before...
  21. D

    Wiki Humana and DMEs

    Please help. My podiatry practice bills out for DME products such as post-op shoes and pneumatic walkers. Humana has lately been denying them for incorrect modifiers. We have used LT, RT, Medicare modifiers, any modifiers we can find to try to get these paid for. Has anyone else had this...
  22. D

    Wiki RAC/Braces supplied to IP

    We've been RAC'd for knee braces supplied to inpatient's. I know the hospital can't get paid for DME for an inpatient - but shouldn't we be able to be reimbursed? What place of service should have been used? Thanks!
  23. M

    Wiki Dme & icd 10

    Does anyone know anything about DME billing and what it will do to/for DME? I work for an Optician/Optometerist office and my boss (optician) and I are very interested in knowing what the code changes hold, and how different the billing will be. Any information would be appreciated! Thanks...
  24. M

    Wiki DME Oxygen Supplies

    We recently started providing oxygen to patients in home. Some are rentals others are owned. I am confused as to what we can charge for when equipment is rented and owned. I am being told to bill for every little thing we use including tank refills, adapters, peep valves, filter kits, airway...
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