US · guidance
CMS Pub. 100-04, ch. 19, § 90.2.1
Services Billed to the DME MAC
Effective July 1, 2005, IHS suppliers and IHS providers (including CAHs) shall bill the
appropriate DME MAC for DME.
Although, parenteral and enteral nutrients, equipment, and supplies meet the definition of
the prosthetic benefit, they are separately billable to the DME MAC for home use.
Ostomy, tracheostomy, and urological supplies meet the definition of this benefit and are
billed to the DME MAC by IHS suppliers. See §120 of Chapter 15 of Pub. 100-02,
Medicare Benefit Policy Manual for more information on this benefit.
Claims for surgical dressings provided by IHS suppliers shall be billed to the appropriate
DME MAC. Claims for splints and casts provided by IHS suppliers should be billed to
the appropriate A/B MAC (B). See §100 of Chapter 15 of Pub. 100-02, Medicare Benefit
Policy Manual for more information on this benefit.
Effective July 1, 2005, Medicare Part B payment may be made to IHS suppliers that
furnish drugs covered by the DME MAC. The DME MAC drug categories are oral anti-cancer, oral anti-emetic, immunosuppressives, and drugs used for with DME, such as
external infusion pumps and nebulizers. Medicare Part B drugs incident to a physician’s
service shall be billed to the designated A/B MAC (B) when provided in freestanding
facility. See §80, Chapter 17 of Pub. 100-04, Medicare Claims Processing Manual for
more information on this benefit.
Effective July 1, 2005, Medicare Part B payment shall be made to IHS suppliers and IHS
providers (including CAHs) functioning as retail pharmacies dispensing pharmaceuticals
to AI/AN Medicare beneficiaries. These drugs are billed to the appropriate DME MAC.
The A/B MAC (A) shall not be billed for these drugs. Drugs dispensed for self-administration are only covered when billed to the DME MAC if also specifically
covered under Medicare.
Effective July 1, 2005, Medicare Part B payment may be made by the appropriate DME
MAC to IHS suppliers that furnish therapeutic shoes and inserts for individuals with
diabetes. See §140 of Chapter 15 of Pub. 100-02, Medicare Benefit Policy Manual for
more information on this benefit.
History
(Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b21d98bf157d2d4932fc86b5ee7c02dc7ee024e48542012a483cab3ec4800a68
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