Author Topic: DME Medicare billing  (Read 959 times)

Sriram_Sub

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DME Medicare billing
« on: March 30, 2016, 10:49:28 AM »
Hi everyone,

     We have a provider who has been specializing in Sleep Medicine and now would like to become a DME supplier too. This provider has a Group NPI as well as an individual one. We contacted Medicare DME to see if we need to obtain a separate NPI for the DME facility. We were advised that the DME facility can use the same Group NPI of the sleep medicine practice because a separate NPI may be applicable only for a 2nd DME location.

     The rep also said the provider may bill for his ordering services using his individual NPI and the DME supplies under the group NPI. Are there any separate CPT codes for the ordering service or is it just the office visits? Is anybody handling such an arrangement? Please shed some light. Thank you for your help.

Regards
Sriram
Sriram

kristin

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Re: DME Medicare billing
« Reply #1 on: March 30, 2016, 06:21:27 PM »
What does the provider want to supply as DME? Sleep apnea machines, for instance? You do not bill CPT codes to DME, you bill the appropriate HCPCS code, with any necessary modifiers, for the supply/equipment that is being dispensed, using POS 12, for Home. Any related office visit would go to regular Medicare for that date of service, with POS 11, for office.

What do you mean by DME facility? Will the provider not be dispensing the items directly from his primary practice location?

My provider is a podiatrist, and is also a DME supplier, for splints, braces, etc. We have a group NPI for our practice, and she has an individual NPI. When we applied to be a supplier, we used the group NPI. Her individual NPI goes on the claims as the rendering provider/ordering provider, and the group NPI is used for service location and billing location.

Sriram_Sub

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Re: DME Medicare billing
« Reply #2 on: March 31, 2016, 04:00:58 AM »
Thanks Kristin! That gave a better clarity about the NPIs.

Regards
Sriram
Sriram