Chapter 16
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

16.1 DMERC Jurisdiction

The residence of the beneficiary you serve will determine the Durable Medical Equipment Regional Carrier (DMERC) to which you must submit the services(s) being billed. Claims can be submitted to one of the four Durable Medical Equipment Regional Carriers at the following addresses:

 

DMERC Carrier

States in Region

United Health Care
DMERC
PO Box 6800
Wilkes-Barre, PA  18773-6800
(570) 735-9445
Region A: Connecticut, Delaware, Maine,
Massachusetts, New Hampshire, New Jersey,
New York, Pennsylvania, Rhode Island, and
Vermont
Adminastar Federal, Inc.
Assigned Claims: PO Box 7078
Indianapolis, IN 46207-7027
Non-Assigned Claims:
PO Box 7031
Indianapolis, IN 46207-7031
(317) 577-5722
Region B: District of Columbia, Illinois, Indiana,
Maryland, Michigan, Minnesota, Ohio, Virginia,
West Virginia, Wisconsin
Palmetto Government
Benefits Administration
PO Box 100141
Columbia, SC 29202-0141
(803) 691-4300
Region C: Alabama, Arkansas, Colorado, Florida,
Georgia, Kentucky, Louisiana, Mississippi, New
Mexico, North Carolina, Oklahoma, Puerto Rico,
South Carolina, Tennessee, Texas, Virgin Islands
CIGNA
PO Box 690
Nashville, TN 37202
(615) 251-8182
Region D: Alaska, Arizona, California, Guam,
Hawaii, Idaho, Iowa, Kansas, Missouri, Montana,
Nebraska, Nevada, North Dakota, Oregon, South
Dakota, Utah, Washington, Wyoming

Physicians and suppliers with enrollment questions and related issues should contact the National Supplier Clearinghouse at (803) 754-3951.

16.2 Where to Send DMEPOS Claims

The Health Care Financing Administration has advised Medicare carriers of the durable medical equipment, prosthetic, orthotic, and supply (DMEPOS) items, supplies and services which will be processed by the Durable Medical Equipment Regional Carrier (DMERC).

The following items, supplies, and services will be processed by the local carrier:

 

Code

Description

A0030-A0050 Ambulance Services
A0300-A0999 Ambulance Services
A4220 Refill kit for Implantable Pump
A4260 Levonorgestrel Implant
A4262-A4263 Lacrimal Duct Implant
A4270 Endoscope Sheath
A4300-A4301 Implantable Catheter
A4470 Gravlee Jet Washer
A4480 Vabra Aspirator
A4550 Surgical Trays
A4575 Topic Hyperbaric Oxygen Chamber, Disposable
A4580-A4590 Casting Supplies & Material
A4610 Medication Supplies for DME
A4641-A4646 Imaging Agent; contrast
A4647 Contrast Material
A9150 Non-prescription Drugs
A9160-A9170 Administrative, Miscellaneous, and Investigational
A9190-A9270 Noncovered Items or Services
A9500-A9505 Imaging Agents
D0120-D9999 Dental Procedures
E0746 EMG Device
E0749 Implantable Osteogenic Stimulator
E0751-E0753 Implantable Nerve Stimulators
E0782-E0783 Infusion Pump, Implantable
G0001-G0122 Misc. Professional Services
J7190-J7192 Factor VIII
J7194 Factor IX
J7196 Other Hemophilia
J7197 Antithrombin
L8600-L8699 Prosthetic Implants
M0064-M0302 Medical Services
P2028-P9615 Laboratory Tests
Q0034-Q0035 Influenza Vaccine; Cardiokymography
Q0068 Extra Corporeal Plasmapheresis
Q0081 Infustion Therapy
Q0082 Activity Therapy
Q0083-Q0085 Chemotherapy
Q0086 Physical Therapy Evaluation Treatment
Q0091 Smear Preparation
Q0092 Portable X-ray setup
Q0111-Q0116 Miscellaneous Lab Services
Q0136 Injection, Epoetin Alpha
Q0163-Q0181 Oral Anti-emetic Drugs
R0070-R0076 Diagnostic Radiology Procedures
V2630-V2632 Intraocular Lens
V2785 Processing-Corneal Tissue
V5008-V5299 Hearing Services
V5362-V5364 Speech Screening

The items and supplies listed below are considered "incident to" a physician service and are not separately reimbursable. However, if these supplies are given to a patient as a take home supply, the claim should be submitted to the DMERC.

 

Code

Description

A4206-A4209 Medical, Surgical, and Self-Administered Supplies
A4211-A4215 Medical, Surgical, and Self-Administered Supplies
A4221-A4250 Medical, Surgical, and Self-Administered Supplies
A4265 Paraffin
A4454-A4455 Tape; Adhesive Remover
A4460-A4462 Elastic Bandage
A4556-A4558 Electrodes; Lead Wires; Conductive Paste
A4615-A4629 Oxygen and Tracheostomy Supplies
A4649 Miscellaneous Surgical Supplies
A4712 Water, Sterile
A6020 Surgical Dressing
A6154-A6406 Surgical Dressing

The following procedure codes may be reimbursable when performed in a physician’s office if “incident to” a physician’s services. However, if the services are provided outside the physician’s office, claims should be sent to the DMERC.

 

Code

Description

J0120-J3570 Injection
J7030-J7130 Miscellaneous Drugs and Solutions
J7310 Ganciclovir
J7500-J7599 Immunosuppressive Drugs
J7610-J7699 Inhalation Solutions
J9000-J9999 Chemotherapy Drugs

For the services listed below, if the patient's condition is temporary, the services aren't separately reimburseable and claims should be submitted to the local carrier. If the patient's condition is permanent, supplies may be reimbursed and should be submitted to the DMERC.

 

Code

Description

A4310-A4335 Incontinence Supplies/Urinary Supplies
A4338 Indwelling Catheter, Foley Type
A4340 Indwelling Catheter, Specialty Type
A4344-A4346 Indwelling Catheter, Foley Type
A4347-A4359 Incontinence/Urinary Supplies
A4361-A4421 Ostomy Supplies
A5051-A5093 Additional Ostomy Supplies
A5102-A5149 Additional Incontinence and Ostomy Supplies


Epoetin Alfa (EPO) injections (procedure codes Q9920-Q9940) must be billed to the DMERC if the drugs are self-administered, or for Method II ESRD beneficiaries. Method II ESRD beneficiaries are those beneficiaries who have elected home dialysis. Otherwise, submit the service to the local carrier.

Ambulatory Infusion Pump (procedure code E0781) should be billed to the DMERC if the infusion is inititiated in the physician's office and the patient doesn't return during the same day. Otherwise, submit the service to the local carrier.

The following procedure codes will be processed by the local carrier if implanted DME. If
other, these codes should be sent to the DMERC for processing.

 

Code

Description

E1350 Repair or Non-Routine Service
E1399 Miscellaneous DME
L7500-L7520 Repair of Prosthetic Device
L8499 Unlisted Procedure for Miscellaneous Prosthetic Device

The following items, supplies, and services should always be sent to the DMERC Carrier.

 

Code

Description

A4210 Needle Free Injection Device
A4253-A4259 Blood Glucose Test; Lancets; Calibrator Solution
A4465 Non-elastic Binder for Extremity
A4490-A4510 Surgical Stockings
A4554 Disposable Underpads
A4560-A4572 Pessary; Slings, Splints, Rib Belt
A4595 Tens Supplies
A4611-A4613 Oxygen Equipment Batteries
A4630-A4640 Durable Medical Equipment Supplies
A4650-A4705 Supplies for ESRD
A4714-A4927 Supplies for ESRD
A5500-A5507 Therapeutic Shoes
A6025 Silcone Gel Sheet
A9300 Exercise Equipment
B4034-B9999 Enteral and Parenteral
E0100-E0105 Canes
E0110-E0116 Crutches
E0130-E0159 Walkers
E0160-E0179 Commodes
E0180-E0239 Decubitus Care Equipment
E0241-E0246 Bath and Toilet Aids
E0249 Pad for Heating Unit
E0250-E0297 Hospital Beds
E0305-E0326 Hospital Bed Accessories
E0350-E0352 Electronic Bowel Irrigation System
E0370 Heel Pad
E0371-E0373 Decubitus Care Equipment
E0424-E0480 Oxygen and Related Respiratory Equipment
E0500 IPPB Machine
E0550-E0585 Compressors
E0600-E0606 Suction Pumps/Room Vaporizers
E0607-E0609 Monitoring Equipment
E0610-E0615 Pacemaker Monitor
E0621-E0635 Patient Lifts
E0650-E0673 Pneumatic Compressor and Appliances
E0690 Ultraviolet Cabinet
E0700 Safety Equipment
E0710 Restraints
E0720-E0745 Electric Nerve Stimulators
E0747-E0748 Osteogenic Stimulators
E0755-E0776 Stimulator; Pole
E0784 Infusion Pumps, Insulin
E0791 Parenteral Infusion Pump
E0840-E0900 Traction Equipment
E0910-E0948 Trapeze Equipment
E0950-E1298 Wheelchairs
E1300-E1310 Whirlpool Equipment
E1353-E1385 Additional Oxygen Related Equipment
E1400-E1406 Additional Oxygen Related Equipment
E1510-E1699 Artificial Kidney Machines and Accessories
E1700-E1702 TMJ Device and Supplies
E1800-E1830 Dynamic Flexion Devices
J7799 NOC, Other than Inhalation Drugs through DME
J8499 Prescription Drug, Oral Non-Chemotherapeutic
J8530-J8999 Oral Anti-Cancer Drugs
K0001-K0109 Wheelchairs
K0112-K0116 Spinal Orthotics
K0119-K0123 Immunosuppressive Drugs
K0137-K0139 Supplies
K0168-K0194 Accessories for Nebulizers, Aspirators, and Ventilators
K0195 Elevating Leg Rests
K0268 Humidifier
K0269 Aerosol Compressor
K0270 Ultrasonic Generator
K0283 Saline Solution, Metered Dose
K0284 External Infusion Pump
K0400 Adhesive Skin Support Attachment for use with Breast Prosthesis
K0401 Deluxe Feature-Therapeutic Shoe
K0407-K0411 Urologicals
K0412 Immunosuppressive Drug
K0415-K0416 Antiemetic Drugs
K0417 External Infusion Pumps
K0440-K0451 Maxillofacial Prosthesis
K0452 Wheelchair Bearings
K0453 Injection, Amphotericin B
K0455 Infusion Pump used for Uninterrupted Administration of Epoprosternal
K0501 Aerosol Compressor
K0503-K0528 Inhalation Solution
K0529 Nebulizer Spray-Water/Solution
K0530 Nebulizer
L0100-L4398 Orthotic
L5000-L5999 Lower Limb
L6000-L7499 Upper Limb
L7900 Vaccum Erection System
L8000-L8490 Prosthetic Procedures
L8500-L8501 Artificial Larynx; Tracheostomy Speaking Valve
Q0132 Dispensing Fee - Nebulizer Drug
V2020-V2025 Frames
V2100-V2513 Lenses
V2530-V2531 Contact Lenses, Scleral
V2600-V2615 Low Vision Aids
V2623-V2629 Prosthetic Eyes
V2700-V2780 Miscellaneous Vision Service
V2781 Progressive Lens
V2799 Misc. Vision Service
V5336 Repair/Modification of Augmentative Communicative System
or Device