Home may be where the heart is, but the Centers for Medicare & Medicaid Services (CMS) has much more exacting standards when it comes to the DME benefit.
In response to what it calls “an increased number of questions in regards to what place of service durable medical equipment, prosthetics, orthotics and supply items are covered,” National Government Services (NGS), the Jurisdiction B DME MAC, sent out a bulletin to remind suppliers of its coverage policies.
“Medicare payment is available for rental or purchase of durable medical equipment used in a beneficiary’s home,” the April 25 bulletin said. “A beneficiary’s home may be his/her own dwelling, an apartment, a relative’s home, a home for the aged or other type of institution. However, an institution may not be considered a beneficiary’s home if it is a hospital or a skilled nursing facility.”
NGS gave the following list of place-of-service codes that qualify for the DME benefit:
• 01: Pharmacy
• 04: Homeless shelter
• 09: Prison/correctional facility
• 12: Home
• 13: Assisted living facility
• 14: Group home
• 33: Custodial care facility
• 54: Intermediate care facility/mentally retarded
• 55: Residential substance abuse treatment facility
• 56: Psychiatric residential treatment center
• 65: End-stage renal disease treatment facility (for parenteral nutritional therapy)
“If an individual is a patient in an institution or a distinct part of an institution that meets the definition of a hospital or skilled nursing facility, the individual is not entitled to have separate Part B payment made for rental or purchase of DME,” the bulletin said. A full list of codes can be found at cms.gov/PlaceofServiceCodes.
