The repair and replacement policy for DME in Medicare’s national competitive bidding program has changed, the Centers for Medicare & Medicaid Services (CMS) announced Dec. 12.
As a result, there is a new Fact Sheet explaining CMS’ policy.
A bulletin distributed by National Government Services (NGS), the Jurisdiction B DME MAC, said, “The policy now considers repair parts to include components that are needed to repair the base equipment, including batteries and tires. Additionally, the revised fact sheet provides guidance on billing the labor component and parts for the repair for beneficiaries who reside in competitive bid areas.”
The Fact Sheet notes that certain parts of the policy would remain unchanged, including the fact that any Medicare-enrolled supplier can provide the replacement part needed to make a “competitively bid, beneficiary-owned equipment… serviceable,” and any Medicare-enrolled supplier can also make the repair.
Parts included in the new policy “include components that are needed to repair the base equipment. Parts also include certain specified items — i.e., tires, batteries, and wheels — that may be replaced in their entirety.”
Also eligible for repair under the policy: options and accessories — such as elevating legrests, adjustable armrests and seating systems — composed of multiple parts. The Fact Sheet said, however, “The entire accessory or optional item must not be replaced as part of a repair, as they are considered as separately covered items, not as a component part of the base equipment.”
Regarding repairs, the Fact Sheet says, “Claims for the labor component of repair of patient-owned equipment are not subject to competitive bidding and will be paid according to Medicare’s general payment rules.” The supplier may, however, be required to submit a separate claim for any competitively bid parts rather than submitting a single claim for labor and all parts.
Under the policy, suppliers are required to keep documentation regarding what item is being repaired and why.
Some items, CMS said, “may never be considered replacement parts associated with repair of base equipment.” Those items include standard power chair and replacement seat cushions (HCPCS coded E2601-E2608 and E2622-E2625) and replacement back cushions (E2611-E616, E2620, E2621) unless the back cushions are “integral to base equipment.”
The policy for items such as those wheelchair seat cushions and backs requires beneficiaries in a competitively bid area to obtain replacement equipment from a supplier participating in the competitive bidding program. But if a part of the cushion, for instance, needs to be repaired, that action could fall under the repair policy.
“If a damaged valve stem on a beneficiary-owned seat cushion is being replaced in order to repair the seat cushion,” the Fact Sheet says, “the replacement valve stem can be considered a repair part.”
