License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association website.
Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.

Print | Bookmark | Email | Font Size: + | –

March 4, 2024

Billing Repairs of DMEPOS Items Reminder

The DME MAC Jurisdiction B Supplier Manual, Chapter 5, defines a repair as to "fix or mend and to put the equipment back in good condition after damage or wear." Fee for Service (FFS) Medicare will consider coverage of repairs for items owned by the beneficiary. Medicare does not separately reimburse for repairs of items in the frequent and substantial servicing payment category, oxygen equipment, capped rental items during the rental period, items covered under a manufacturer warranty, or previously denied items.

Documentation

FFS Medicare does not require a standard written order for repairs. An order for repairs is acceptable to keep it in the beneficiary's file and you may submit that order if documentation is requested by an auditing entity. Medicare may pay for repairs to a beneficiary owned DMEPOS item if Medicare paid for the base item. With respect to Medicare reimbursement for the repair, there are two documentation requirements:

The treating practitioner must document that the DMEPOS item repaired continues to be reasonable and necessary; and,
Either the treating practitioner or the supplier must document that the repair itself is reasonable and necessary.

The supplier must keep detailed records describing the need for all repairs including a detailed explanation of the justification for any component or part replaced and the labor time to restore the item to its functionality.

Billing for Repairs

When billing for repairs to beneficiary-owned equipment, suppliers must provide specific information to the DME MACs.

Include in the claim narrative:

HCPCS code and date of purchase (month and year) of the equipment repaired.
- For example: "E0260, del-06/19" would show a semi-electric hospital bed with initial delivery date June 2019.
- If the HCPCS code is not available, include the manufacturer's name, product name and model number (ex. "Drive Medical, Competitor Bed, Model-15571FR-PKG, del-06/19").
Information of the repair item provided. Include the manufacturer's name, product name, model number, supplier price list amount, and the need for the repair.
Example: If the motor for a semi-electric hospital bed failed and the beneficiary needs a replacement, the claim narrative might look like this: "Replace Drive hospital bed motor, #15038MO, Price-$250.00, motor broken."

Use a miscellaneous code when a HCPCS code is not available and include the claim narrative information listed above.

E1399 – durable medical equipment
K0108 – wheelchair accessories

Add the RB modifier to report repair/replacement parts for a beneficiary owned DMEPOS piece of equipment.

Only 80 characters are available for the claim narrative. If you need to use abbreviations, please refer to the CGS Abbreviation List for Submitting Narrative Information.

Labor Charges for Repairs of DME

CGS will consider payment for labor charges for the time spent repairing a piece of equipment. Use HCPCS code K0739 where one unit of service (UOS) is equal to 15 minutes of labor time on the claim with the repairs. The DME MAC Jurisdiction B Supplier Manual, Chapter 5 includes a table with the most common repairs and associated labor times. For the repairs listed in the table, only bill the allowable UOS for that specific repair, even if it takes the technician longer to repair the equipment.

Example: FFS Medicare allows one UOS to replace a wheel/tire on a wheelchair. That task may take the technician longer than the 15 minutes allowed for one unit of service, but the supplier may only bill Medicare for one UOS of K0739 as listed on the table.

For other repairs, the supplier's records should document what they repaired, the reasonable time spent on those repairs, and bill Medicare accordingly.

Equipment on Loan to Beneficiaries

Sometimes it is necessary for a supplier to loan an item while repairing the beneficiary-owned equipment (example: a power wheelchair or a PAP device). In these instances, the supplier can bill Medicare for a one-month rental for the use of their "loaner" item while repairing the beneficiary's equipment. The HCPCS code for these scenarios is K0462 – Temporary replacement for beneficiary-owned equipment repaired. Please refer to the DME MAC Jurisdiction B Supplier Manual, Chapter 5, Section 9 for more information.

Repairs to Orthotics & Prosthetics

The repair and labor for orthotic and prosthetic items and the applicable HCPCS codes are published in the Local Coverage Determination (LCD)-related policy articles for the item in question. Here is an overview of those codes:

L4205 – Labor component for repair of an orthotic device, per 15 minutes
L4210 – Miscellaneous code for minor materials or replacement parts for an orthotic device
L7510 – Miscellaneous code for minor materials/parts for prostheses where there is not a HCPCS code
L7520 – Miscellaneous code for labor associated with adjustments and repairs that do not involve replacement parts or parts billed with code L7510, per 15 minutes

Include all codes for repairs of orthoses billed with the same date of service on the same claim. Do not use the labor HCPCS codes noted above for evaluations of the beneficiary, to determine problems with the product, or in adjusting during follow-up visits or assessments. Do not bill labor to the Medicare program when there is a specific L-code for the part replaced. Payment for the L-code includes labor for that specific L-code.