US · guidance
CMS Pub. 100-02, ch. 15, § 300.5.1
Special Claims Processing Instructions for A/B MACs (A)
• Coding and Payment Requirements
The provider bills for DSMT on Form CMS-1450 or its electronic equivalent.
The cost of the service is billed under revenue code 942 in FL 42 “Revenue
Code.” The provider will report HCPCS codes G0108 or G0109 in FL 44
“HCPCS/Rates.” The definition of the HCPCS code used should be entered
in FL 43 “Description.”
• Applicable Bill Types
The appropriate bill types are 12x, 22x, 13x, 34x (can be billed if service is
outside of the treatment plan), 72x, 74x, 75x, 83x and 85x.
History
(Rev. 24, Issued: 10-29-04, Effective: 01-01-05, Implementation: 01-03-05)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a6b790da350ea1e2c66bd59fe223629a9fb58d0f40bbe2c57c80d1b5432bfd3f
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