Wiki Coding dme's in medical office/issues with modifers/medicare

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KZimmerman01

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I am looking for some direction with DME's. We are a Family Practice, but we have a Physical Therapy department in our organization. We bill out DME's periodically. We are having issues getting them to go out the door with Medicare. We have tried all modifiers that we know to use and nothing works.
The codes that we are trying to submit are listed below. Any help will be appreciated.

L0627
L1812
L3010
 
Are you submitting the claims to Part B? If so, that would be why you're having troubles - DME items are processed and paid by separate contractors (DME regional contractors, or DMERC) from those that pay Part B claims. If you want to be a DME supplier for Medicare patients, your practice will need to enroll with the DMERC that is responsible for your geographic region and submit your claims to them. Here's a web link that's a good starting point for more information: https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html
 
To piggyback on what Thomas said, getting enrolled with a DME contractor is a tremendous hassle. After you research the costs and time sink, you may just say the heck with it - depending on how many supplies are going out the door. Our clinic director just decided it would be easier to eat the cost

I'm guessing the reimbursement for your PT orthotics will not even come close to justify enrollment. YMMV
 
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