CMS Pub. 100-04, ch. 1, § 10.1.5.1

Orthotics, Supplies, Parental and Enteral Nutrition (PEN)

(Rev. 2487, Issued: 06-08-12, Effective: 01-01-11, Implementation: 06-19-12)

B3-3116, B-3102

Claims for DMEPOS submitted by suppliers for durable medical equipment, prosthetics,

orthotics, and supplies (DMEPOS) are handled by Durable Medical Equipment Medicare

Administrative Contractors (DME MACs).

To determine which services are processed by DME MACs vs. local carriers, CMS

maintains and updates a table of services by HCPCS code that indicates who to bill for

which services. The CMS updates this list by a special One-Time Special Notification as

needed. In general, claims for DMEPOS, other than implanted durable medical

equipment and implanted prosthetic devices, are processed by the appropriate DME

MAC. The appropriate A/B MAC processes claims for implanted durable medical

equipment and implanted prosthetic devices, as well as DMEPOS items incident to a

physician’s service.

Note that surgical procedures for implantable DME or for prosthetic devices, performed

in an inpatient or outpatient hospital setting include the cost of the device in the

Diagnosis Related Group (DRG) or Ambulatory Payment Classification (APC) rate.

However, there are some implantable devices that are eligible for separate pass through

under Outpatient Prospective Payment System (OPPS). DME MACs do not process

claims for DMEPOS items that are subject to consolidated billing or bundled payment

under Prospective Payment System (PPS) or in a DRG.

Claims from parenteral and enteral nutrition (PEN) suppliers are processed by the DME

MAC.

Method II ESRD claims for dates of service prior to January 1, 2011, are also processed

by the DME MAC. For dates of service on and after January 1, 2011, refer to Section

30.3.8 for information regarding the elimination of Method II home dialysis.

The claims processing jurisdiction among DME MACs is determined by the beneficiary’s

permanent address. A beneficiary’s permanent address is determined by where the

beneficiary resides for more than six months of a year. See the CMS Web site at

http://www.cms.hhs.gov/contacts/incardir.asp for a list of State jurisdictions by DME

MAC.