Wiki POS for DME

[tanzaldua]

BCBS has been telling our patients that if we bill their charge for their custom orthotic shoe inserts, they would cover them under the office visit copay. Normally, the correct place of service for DME would be 12 (home). But when we bill it that way, the charge more frequently applies to the patient's deductible. Then BCBS tells our patients that had we billed with POS 11 (office) it would have been covered under their copay. The problem is, I can find clear policies for many other carriers (Medicare, Humana, UHC) that says DME should be billed w POS 12. But not with BCBS. Their policy only states that equipment qualifies if DME is intended to be used at home, it says nothing about where it's dispensed.
Additionally, I'm not so sure these custom inserts are intended to be used at home anyway. They are intended to be used wherever the patient goes. I have previously written to our BCBS rep and received this answer:



BCBS Policy does reference some CMS policies in their policies, but they don't appear to be the policy that says "you must bill all DME with POS 12"...
Does anyone have anything that points me to the correct, definitive answer for this question? This is BCBS of Texas.

 

[BelindaNew19]

Contact your contract representative for the practice with Anthem to have documentation from the carrier. When billing DME for a pain management office POS 11 is used and claims are processed accordingly. There are various insurances that require the POS 12 such as UHC commercial plan, MMOH, Humana and Medicare. It is always best when you are unable to locate the information in the provider manual to seek assistance from your contract rep to provide you guidance or provide you with a contact to make sure you are following the contract and billing accordingly.