CMS Pub. 100-04, ch. 20, § 212

DMEPOS Suppliers

(Rev. 2977, Issued; 06-20-14, Effective: 09-23-14; ICD-10: Upon Implementation of ICD-10, Implementation: 09-23-14; ICD-10: Upon Implementation of ICD-10)

Section 1842 (b)(6)(F) of the Social Security Act requires consolidated billing of all

home health services while a beneficiary is under a home health plan of care authorized

by a physician. Consequently, Medicare makes payment for all such items and services

to a single home health agency (HHA) overseeing that plan.

The law states payment will be made to the HHA without regard as to whether or not the

item or service was furnished by the agency, by others under arrangement to the HHA, or

when any other contracting or consulting arrangements exist with the primary HHA, or

“otherwise.” Payment for all items is included in the home health prospective payment

system (HH PPS) episode payment the HHA receives.

Nonroutine medical supplies are among the types of services that are subject to the home

health consolidated billing provision. Medicare periodically publishes Recurring Update

Notifications that contain updated lists of nonroutine supply codes that must be included

in home health consolidated billing. These services may not be billed separately by a

DMEPOS supplier when a Medicare beneficiary is in a HH PPS episode of care.

Durable Medical Equipment (DME), including prosthetics, orthotics and oxygen, is

exempt from home health consolidated billing by law.

For detailed information regarding home health consolidated billing, DMEPOS suppliers

should refer to chapter 10, section 20 of this manual.