|Billing Procedures for Upgrades|
Medicare payment for upgrades will be based upon the payment amount applicable to the item in the area in which the beneficiary resides...
| Enteral Nutrition (PDF, 153 KB)|
With the exception of SNFs and NFs that become specialty suppliers, suppliers that are contract suppliers for the enteral nutrition product category must furnish services to beneficiaries throughout CBA, regardless of whether a beneficiary lives in a private residence or institutional setting...
|Grandfathering and Oxygen Modality|
MLN Article summarizing the key points of CR 6692, which describes changes in the way grandfathered oxygen competitive bidding claims are processed following a change in stationary or portable equipment modality under Round 1 of the DMEPOS Competitive Bidding Program...
| Grandfathering for Rented DME (PDF, PDF - 599 KB)|
Suppliers that are not awarded a competitive bidding contract for furnishing rented DME in a CBA can decide to be grandfathered suppliers for beneficiaries to whom they are furnishing these items at the time the competitive bidding program is implemented...
| Grandfathering for Rented Oxygen (PDF, PDF - 590 KB)|
Suppliers that are not awarded a competitive bidding contract for furnishing oxygen and oxygen equipment in a CBA can decide to be grandfathered suppliers for beneficiaries to whom they are furnishing these items at the time the competitive bidding program is implemented...
| Mail-Order Diabetic Supplies (PDF, PDF - 107 KB)|
The term “mail-order” refers to items ordered remotely and delivered to a beneficiary’s residence by common carriers and does not include items obtained by beneficiaries from local supplier storefronts...
|MLN Matters: Purchased Accessories and Supplies for Use With Grandfathered Equipment - KY Modifier|
This article was revised on January 10, 2011, to clarify and add language regarding the use of modifier KY.
| Prescription for Specific Brand or Mode of Delivery (PDF, PDF - 180 KB)|
The Medicare DMEPOS Competitive Bidding Program includes a special beneficiary safeguard to ensure that beneficiaries have access to specific brands or modes of delivery of competitively bid items when needed to avoid an adverse medical outcome...
|Repairs and Replacements|
This fact sheet contains important information about repairs and replacements of beneficiary-owned equipment under the DMEPOS Competitive Bidding Program.
|Traveling Beneficiary Fact Sheet|
This fact sheet is designed to provide education to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers that provide items to Medicare beneficiaries who reside in or travel to competitive bidding areas. It includes information on how to determine whether a beneficiary is in a traveling status, how to properly bill Medicare for the item, and how Medicare will determine the payment amount.