CMS Pub. 100-04, ch. 20, § 160.1

Furnished to Part B Inpatients

(Rev. 2993, Effective: ASC X12 - 01-01-12, ICD-10 - Upon Implementation of ICD- 10; Implementation: ASC X12 - 08-25-14, ICD-10 - Upon Implementation of ICD- 10)

Inpatient Part A hospital or SNF care includes total parenteral nutrition (TPN) systems

and enteral nutrition (EN).

For inpatients for whom Part A benefits are not payable (e.g., benefits are exhausted or

the beneficiary is entitled to Part B only), total parenteral nutrition (TPN) systems and

enteral nutrition (EN) delivery systems are covered by Medicare as prosthetic devices

when the coverage criteria are met. When these criteria are met, the medical equipment

and medical supplies (together with nutrients) being used comprise covered prosthetic

devices for coverage purposes rather than durable medical equipment. However,

reimbursement rules relating to DME continue to apply to such items.

When a facility supplies TPN or EN systems that meet the criteria for coverage as a

prosthetic device to an inpatient whose care is not covered under Part A, the facility must

bill one of the DME MACs. Additionally, HHAs, SNFs, and hospitals that provide PEN

supplies, equipment and nutrients as a prosthetic device under Part B must use the ASC

X12 837 professional claim format or if permissible the Form CMS-1500 paper form to

bill the appropriate DME MAC. The DME MAC is determined according to the

residence of the beneficiary. Refer to §10 for jurisdiction descriptions.

A/B MACs (A) and (HHH) return claims containing PEN charges for Part B services

where the bill type is 12x, 13x, 22x, 23x, 32x, 33x, or 34x with instructions to the

provider to bill the DME MAC.