DME billing allowed POS codes

 PLACE OF SERVICE CODES

DMEPOS Place of service codes acceptable to report for DMEPOS claims submitted by medical suppliers are as follows:

* 01 – Pharmacy

* 04 – Homeless Shelter

* 12 – Home

* 13 – Assisted Living Facility

* 14 – Group Home

* 16 – Temporary Lodging

* 31 – Skilled Nursing Facility

* 32 – Nursing Facility

* 33 – Custodial Care Facility

Nursing Facility

Residents

For residents in a skilled nursing facility or a nursing facility, many medical supplies and/or items or DME are considered a part of the facility's per diem rate. For verification of specific procedure codes that may be billed by the medical supplier, refer to the Medicaid Code and Rate Reference tool. (Refer to the Directory Appendix for website information.)


EVALUATION AND MANAGEMENT SERVICES

Coding CPT E/M service guidelines apply for determining what level of care is appropriate.

Generally, CPT descriptions for E/M services indicate "per day" and only one E/M service may be reported per date of service (DOS). Preventive Medicine E/M Visit and Another E/M Visit on the Same Date

A preventive medicine E/M visit and another E/M visit on the same date are billed separately if, during the preventive visit, a problem or abnormality is detected which  requires additional work which meets the key component requirements of a problemoriented E/M visit. When this occurs, bill the office/outpatient E/M procedure code using modifier 25 and bill the preventive E/M visit without using a modifier. Refer to CPT guidelines for additional information.

If the same level of care E/M visit is provided twice on the same day, report on one service line and use modifier 22. Indicate the time of day for each visit in item 19.

Procedures and New E/M Service

A procedure and a new patient E/M service on the same date should be reported using modifier 25 on the E/M service line.

EPSDT Developmental Screening

The developmental screening using an objective standardized tool is billed using the appropriate CPT E/M codes for the visit. A maximum of three screenings per beneficiary are allowed in one day by a single provider.

Consultations Consultations require the referring/ordering provider’s name and NPI in items 17 and 17b.

Office Emergency Services

To report emergency services in the office, report the applicable procedure (e.g., laceration repair) or the E/M office visit that represents the level of care provided.


Hospital ED Reimbursement 

E/M services provided in the hospital emergency department (ED) by the attending physician (MD, DO) are reimbursed on a two-tiered case rate based on whether the beneficiary was released or admitted. If the beneficiary was released from the ED, a single rate is used as the fee screen. If the beneficiary was admitted to the hospital or transferred to another hospital from the ED, a higher single rate is used as the fee screen. Physicians must bill the level of service identified in the CPT coding descriptions to ensure proper reimbursement.

Miscellaneous Services such as telephone calls, missed appointments, interpretations of lab results, and services of an interpreter cannot be billed as separate services or billed to the beneficiary.