Billing for Durable Medial Equipment (DME), Orthotic/Prosthetic Devices, and Supplies (including Surgical Dressings)

A SNF may not bill for DME furnished to its Part A inpatients as necessary DME must be supplied to the beneficiary as part of SNF services. A SNF may not bill for DME furnished to its Part B inpatients or outpatients. However, a SNF may qualify as a supplier and enroll with the National Supplier Clearinghouse. In such cases, the SNF is given a separate supplier number to bill outpatient DME to the DME MAC. The DME MAC will furnish billing guidelines and payment will be made directly to the SNF as a supplier.

The SNF or other entity that furnishes prosthetic and/or orthotic devices to SNF residents for whom Part A benefits are not payable (no Part A entitlement or benefits exhausted) and for SNF outpatients may bill for such items.

Prosthetic and orthotic devices are:

• Prosthetic devices (other than dental) that replace all or part of an internal body organ (including connective tissue) or replace all or part of the function of a permanently inoperative or malfunctioning internal body organ, including replacement or repair of such devices .

• Leg, arm, and neck braces, trusses, and artificial legs, arms, and eyes, including adjustments, repairs, and replacement required because of breakage, wear, loss, or a change in the patient's physical condition 

SNFs bill supplies to its A/B MAC (A) for outpatients.

Billing 

The SNF must bill the A/B MAC (A) for prosthetic/orthotic devices, supplies and surgical dressings using the ASC X12 837 institutional claim format or if permissible Form CMS-1450. 

The SNF must bill prosthetic and orthotic devices under revenue code 274, along with the appropriate HCPCS code. When billing for maintenance and servicing of these items, revenue code 274 along with the appropriate HCPCS code must be used.

The SNF should report "Units of Service" on Form CMS-1450 the number of items billed to the SNF's A/B MAC (A) for orthotics and prosthetics.

Supplies may be billed for SNF outpatients under revenue code 270. Payment is made based on a fee schedule.

The SNF should bill the A/B MAC (A) for surgical dressings under revenue code 623. HCPCS codes for reporting surgical dressing are normally found in the Level II HCPCS codes in the A6000 series. The A/B MAC (A) makes payment based on the surgical dressing fee schedule.

SNFs use 22X type of bill for orthotic and prosthetic devices and surgical dressings when billing for its Part B inpatients. Orthotic and prosthetic devices, surgical dressings, and supplies for outpatients are billed with 23X type of bill.