CMS Pub. 100-04, ch. 1, § 10.1

Payment

(Rev. 10840; Issued: 06-11-21; Effective: 07-12-21; Implementation: 07-12-21)

B3-3100

A/B MACs (Part B) have jurisdiction for all claims from the following:

• Physicians;

• Other individual practitioners;

• Groups of physicians or practitioners;

• Labs not part of a hospital;

• Ambulance claims submitted by ambulance companies under their own Medicare

number (hospitals may operate ambulances as part of the hospital and bill the A/B

MAC (Part A);

• Ambulatory surgical centers (ASCs); and

• Independent diagnostic testing facilities (IDTFs).

Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have

jurisdiction for claims from the following:

• Nonimplantable durable medical equipment, prosthetics, orthotics, and

supplies (DMEPOS) (including home use);

• Suppliers of enteral and parenteral products other than to inpatients covered

under Part A;

• Oral drugs billed by pharmacies; and

• Method II home dialysis (for dates of service prior to January 1, 2011). Note:

Please refer to Section 30.3.8 for information regarding the elimination of

Method II home dialysis for dates of service on and after January 1, 2011.

The CMS maintains a list of which HCPCS codes are under DME MAC only jurisdiction

or dual DME MAC/Part B MAC jurisdiction and issues updates to DME MACs and A/B

MACs (Part B) as needed (Usually quarterly). Any other codes not listed as DME MAC

only or dual DME MAC/Part B MAC jurisdiction shall be A/B MAC (Part B) only

jurisdiction.

There are four DME MACs each of which is assigned specific States.

A/B MACs (Part B) typically process Part B fee-for-service claims for services furnished

in specific geographic areas (e.g., a State). However, a single A/B MAC (Part B)

processes all physician/supplier claims for railroad retirement beneficiaries. (See §10.1.3

for claims for Part B medical services performed outside the U.S. for individuals who

reside in the U.S.).

The rules for determining jurisdiction are the same whether a claim is assigned or

nonassigned (see §30.3 for assignment rules).

Further information on A/B MACs (Part B) and DME MACs for specific geographic

areas is available on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs .

Most skilled nursing facilities submit claims to the A/B MACs (Part A). However, a

nonparticipating skilled nursing facility (SNF) is considered a supplier and its claims are

submitted to the appropriate A/B MACs (Part B) under its own Medicare supplier

number.