HCPCS E0246 (Transfer Tub Rail Attachment) is a valid DMEPOS code, but Medicare pricing is not found on the Physician Fee Schedule. Instead, DME suppliers must look at the DMEPOS Fee Schedule.
If you are unable to find a fee amount, I would recommend:
1. Verify that E0246 is covered by Medicare for the beneficiary's circumstances. Not all DMEPOS items with a HCPCS code are covered benefits.
2. Check the CMS DMEPOS Fee Schedule or your DME MAC's fee schedule lookup tool rather than the MPFS.
3. Confirm whether the item is subject to a state-specific fee amount, competitive bidding adjustment, or has been designated as non-covered.
4. Review any applicable LCDs or policy articles from your DME MAC.
If Medicare does not have an allowable amount for the code in your jurisdiction, many commercial payers will require your usual and customary charge, but Medicare claims can only be reimbursed when CMS has established coverage and pricing rules.
Can you share whether you're billing Medicare Part B directly as a DME supplier and what state you're located in? The answer may vary by DME MAC jurisdiction.
Dee Daniels
Founder | Elevare Management Solutions
Revenue Cycle Management Consultant
www.elevaremgmts.com