CMS Pub. 100-04, ch. 7, § 60.3

Prosthetic Device

(Rev. 1, 10-01-03)

(Rev. 3053, Issued: 08-28-14, Effective: ICD-10: Upon Implementation of ICD-10 ASC-X12: 01-01-12, Implementation ICD-10: Upon Implementation of ICD-10; ASC X12: 09-30-14)

Parenteral nutritional (PEN) therapies including the necessary equipment, medical

supplies and nutrients provided to an inpatient (where Part A payment cannot be made),

or to individuals who are not inpatients are covered as a prosthesis under the Part B

prosthetic device benefit as long as the requirements in the Coverage Manual are met,

and the required documentation is submitted.

The SNF or the supplier must bill the DME MAC. The SNF or supplier should refer to

the most recent HCPCS directory or billing instructions distributed by the DME MAC for

current HCPCS coding information. If the SNF bills the DME MAC., it must obtain a

supplier number from the National Supplier Clearinghouse and must use the ASC X12

837 professional claim format, or if permissible Form CMS-1500.

Billing Instructions are in the Medicare Claims Processing Manual, Chapter 26,

"Completing and Processing the Form CMS-1500 Data Set."

DME MAC jurisdictions are based on the residence of the beneficiary. The DME MAC

for each State is shown on the CMS Web site at

http://www.cms.hhs.gov/medicare/medicare-contracting/medicare-administrative-

contractors/medicareadministrativecontractors.html .