Billing for Supplies and Drugs Related to the Effective Use of DME - Reporting NDC code

Suppliers and providers bill supplies that are necessary for the effective use of DME, including drugs, with the appropriate HCPCS code identifying the supply. HHAs must also report revenue code 0294, "Supplies/Drugs for DME Effectiveness."

Suppliers and providers, other than HHAs, bill supplies and drugs (not including drugs that are necessary for the effective use of implanted DME) that are necessary for the effective use of DME to the DME MACs. HHAs bill the A/B MACs (HHH).

Suppliers and providers, other than HHAs, bill for drugs that are necessary for the effective use of implanted DME (HCPCS codes E0751, E0753, E0782, and E0783) to the A/B MAC (B). HHAs bill the A/B MAC (HHH).

The A/B MACs (HHH) contact the DME MAC or A/B MAC (B) as necessary to determine drug prices.

The DME MACs must:

• accept NDC codes for all drugs billed in the NCPDP format;

• accept NDC codes for oral anti-cancer drugs billed in the ASC X12 837 professional claim format, NCPDP format, and paper Form CMS-1500;

• accept HCPCS for all other drugs billed in the ASC X12 837 professional claim format and paper Form CMS-1500 and

• return as unprocessable claims submitted with an invalid NDC using the appropriate Remittance Advice Remark Code..

See http://www.wpc-edi.com/codes/Codes.asp for a current list of the Remittance Advice Remark Codes.