CMS Pub. 100-04, ch. 20, § 140.1.1

Furnished Through Durable Medical Equipment

(Rev. 12013; Issued: 05-02-23; Effective: 07-01-23; Implementation: 07-03-23)

Section 1833(b) of the Social Security Act (the Act) is amended by Section 11407 of the

Inflation Reduction Act, which waives the Medicare Part B deductible beginning July 1,

2023 for insulin furnished through an item of durable medical equipment covered under

section 1861(n) of the Act. Also, Section 1833(a) of the Act is amended by Section

11407 of the Inflation Reduction Act, which requires that beneficiary coinsurance for a

month’s supply of insulin furnished through an item of durable medical equipment is not

to exceed $35 beginning July 1, 2023. The supplier payment is to be adjusted as

necessary so that Medicare pays for the rest of the amount for the month’s supply of

insulin.

Effective July 1, 2023, to ensure the appropriate coinsurance is applied all claims billing

for insulin administered through an item of DME must have a modifier appended to

identify if the supply is for one month or a three month supply. Claims submitted for

insulin administered through an item of DME that do not include one of the modifiers

listed below will be returned to the supplier as un-processable.

JK - Short Descriptor: Drug supply 1 month or less;

Long Descriptor: One month supply or less of drug or biological

or

JL- Short Descriptor: Drug 3 month supply;

Long Descriptor: Three month supply of drug or biological