Billing Instructions and Information
- Billing Instruction Articles
- Certificates of Medical Necessity (CMNs) & DME Information Forms (DIFs)
- Charts & Job Aids
- Competitive Bidding Program
- Correct Coding Articles
- CR Modifier Usage for COVID-19 PHE
- HCPCS Updates
Billing Instruction Articles
- 2023 DMEPOS HCPCS Code Jurisdiction List - April Update – 04.24.23
- DMEPOS HCPCS Code Jurisdiction List – October 2022 Update – 10.27.22
- DMEPOS HCPCS Code Jurisdiction List – April 2022 Update – 04.07.22
- Code Verification Review Requirement for Lower Limb Orthoses (L1832, L1833, and L1851) and Lumbar Sacral Orthoses (L0648 and L0650) – 03.31.22
- Important Billing Reminder for A4258/Spring-Powered Device for Lancet – Blood Glucose Monitors – 03.21.22
- PDAC Code Verification Reviews for CGM Devices – Coding and Billing – 03.17.22
- Reminder About Beneficiary Addresses – 02.09.22
- Medically Unlikely Edits (MUEs) & Clinically Unbelievable Edits (CUEs) – 01.10.22
- Billing Reminders for Secondary Ventilators – 11.23.21
- Revised: CGM Supply Allowance (K0553) Billed with a Span Date: Claims Will Be Denied – 11.04.21
- October Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule (MM12453) – 10.11.21
- KU Modifier for Accessories Used in Conjunction with Complex Rehabilitative Manual Wheelchairs and Certain Other Manual Wheelchairs – 07.15.21
- Billing Reminders for Continuous Glucose Monitors (CGMs) Supply Allowance (K0553) – 06.15.21
- Billing Reminder: Blood Glucose Monitor Supplies and Continuous Glucose Monitor Supplies – Switching – 05.26.21
- Updated Billing Requirements for Home Infusion Therapy (HIT) Services on or After January 1, 2021 – 04.05.21
- Billing Update: K0462 (Temporary Replacement for Patient Owned Equipment Being Repaired) – 02.22.21
- GW Modifier Billing Reminder – 11.16.20
- Drug Invoices – 09.23.20
- Billing for Home Infusion Therapy Services on or After January 1, 2021
[MLN Matters MM11880] – 08.24.20
- Supplier Education on Use of Upgrades for Multi-Function Ventilators
[MLN Matters SE20012] – 06.08.20
- Extension of Payment for Section 3712 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act)
[MLN Matters MM11784] – 05.11.20 NOTE: This article includes information on the use of the KE modifier.
Certificates of Medical Necessity (CMNs) & DME Information Forms (DIFs)
- CMN/DIF Elimination Information – 12.08.22
- Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Information Forms (DIFs) Elimination Reminder – 09.26.22
- CMS Issues Interim Final Rules with Comment (CMS-1744-IFC & CMS-5531-IFC) – COVID-19 Public Health Emergency – Revised – 06.03.22
- Elimination of Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Forms (DIFs) – 05.16.22
Charts & Job Aids
- Advanced Modifier Engine (AME)
- Claim Narratives Chart
- Claim Span Dates & Claim Narratives Chart
- Inpatient Hospital/SNF DMEPOS Claim Submission Reference Aid
Competitive Bidding Program
- Competitive Bidding Program Modifiers Frequently Asked Questions (FAQs) – 09.09.21
- Competitive Bidding Program – Web page for non-contract suppliers with information on KV and KT modifiers
- Competitive Bidding Program Modifiers Frequently Asked Questions (FAQs)
Correct Coding Articles
- 2022 HCPCS Code Update – October Edition – Correct Coding – 10.27.22
- Basics of Choosing the Correct HCPCS Code – Correct Coding – 09.08.22
- 2022 HCPCS Code Update – July Edition – Correct Coding – 06.30.22
- 2022 HCPCS Code Update – April Edition – Correct Coding – Revised – 04.14.22
- Upper Limb Prostheses – Correct Coding – 03.31.22
- Correct Coding and Billing of Halo Procedure – 03.17.22
- Continuous Glucose Monitors – Correct Coding and Billing – Revised – 03.17.22
- Irrigation Supply Sleeves – Correct Coding – 02.10.22
- HCPCS Codes K1018 and K1019 – Correct Coding – 01.20.22
- Enteral Nutrition – Correct Coding and Billing – Revised – 12.16.21
- Parenteral Nutrition – Correct Coding and Billing – Revised – 12.16.21
- Partial Foot, Shoe Insert (Toe Fillers), and Shoe Inserts for Diabetics – Coding Based on Benefit Category – Correct Coding – 12.16.21
- 2022 HCPCS Code Update – January Edition – Correct Coding – 12.16.21
- Correct Coding of Elbow, Shoulder, Shoulder-Elbow-Wrist-Hand and Shoulder-Elbow-Wrist-Hand-Finger Braces (Orthoses) – 11.18.21
- Correct Coding of Finger, Hand, Hand-Finger and Wrist-Hand-Finger Braces (Orthoses) – Revised – 11.18.21
- Articulating Digit(s) and Prosthetic Hands – Correct Coding – Revised – 11.11.21
- Billing and Code Verification of HCPCS Code E0467 (Multi-Functional Ventilator) – Correct Coding – 11.11.21
- Medicare Coverage for Shoes – Correct Coding – Revised – 10.27.21
- 2021 HCPCS Code Update – October Edition – Correct Coding – 10.07.21
- PureWick Urine Collection System – Coding and Billing Instructions – 10.07.21
- Insulin Used with Continuous External Insulin Infusion Pumps – Correct Coding – Revised – 09.30.21
- Warranty, Reasonable Useful Lifetime (RUL), and the Minimum Lifetime Requirement (MLR) for Durable Medical Equipment – Correct Coding – Revised – 09.30.21
- 2021 HCPCS Code Update – July Edition – Correct Coding – Revised – 09.02.21
- 2020 HCPCS Code Update – October Edition – Correct Coding – Revised – 09.02.21
- L1690 Prefabricated Bilateral Lumbo-Sacral Hip Orthosis – Correct Coding – Revised – 08.26.21
- October 2021 HCPCS Updates – New, Revised, and Discontinued HCPCS Codes – 08.31.21
- 2021 HCPCS Code Update – April Edition – Correct Coding – 07.29.21
- Incorrect Use of HCPCS Code A9279 – Correct Coding – Revised – 07.01.21
- Custom Fabricated Wheelchair Seat and Back Cushions – Correct Coding – Revised – 05.13.21
- Custom Fitted Orthotic HCPCS Codes Without a Corresponding Off-the-Shelf Code – Correct Coding – 03.11.21
- Definitions Used for Off-the-Shelf versus Custom Fitted Prefabricated Orthotics (Braces) – Correct Coding – Revised – 03.11.21
- L1005 – Tension Based Scoliosis Orthosis and Accessory Pads, Includes Fitting and Adjustment – Correct Coding – 11.12.20
- L1690 Prefabricated Bilateral Lumbo-Sacral Hip Orthosis – Correct Coding – Revised – 11.12.20
- Billing of Powered L-Coded Items – Correct Coding – Revised – 11.12.20
- Correct Use of Not Otherwise Specified L-codes for Orthoses and Prostheses – Billing Reminder – 10.22.20
- Ankle-Foot Orthoses – Arizona-Type – Correct Coding – REVISED – 10.22.20
- L1686 Prefabricated Hip Abduction Orthosis – Correct Coding – 09.17.20
- Scoliosis Brace – Correct Coding – 07.23.20
- Correct Coding and Coverage of Ventilators – Revised July 2020 – 07.16.20
- Prosthetic Feet and Additions to Lower Limb Extremity Prostheses – Correct Coding and Coding Verification Review Requirement – 06.25.20
- 2020 HCPCS Code Annual Update-Correct Coding – Revised – 02.20.20
CR Modifier Usage for COVID-19 PHE
- CMS Issues Interim Final Rules with Comment (CMS-1744-IFC & CMS-5531-IFC) – COVID-19 Public Health Emergency – Revised – 06.03.22
- CR Modifier for COVID-19 PHE – 02.02.22
- Use of CR Modifier and "COVID-19" Narrative on Specified Claims Due to the COVID-19 PHE – Revised – 05.06.21
- CR Modifier Usage on Claims Impacted by the COVID-19 PHE – 02.22.21
- Billing of Part B Drugs and Enteral Nutrition to DME MACs During COVID-19 Pandemic – Dispensing Amounts – Revised – 05.11.20
- Correct Use of the KX Modifier During the COVID-19 PHE – 05.14.20
- Supplier Reminder: CR Modifier – 05.19.20
- Use of CR Modifier and "COVID-19" Narrative on Specified Claims Due to the COVID-19 PHE – Revised – 05.06.21
- COVID-19: Using the CR Modifier and DR Condition Code – 06.02.20
- Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Adjustments and Modifier Usage – 07.27.20
- Correct Use of the KX Modifier During the COVID-19 PHE – 05.14.20
HCPCS Updates
- October 2022 HCPCS Updates – New and Revised HCPCS Codes – 08.29.22
- July 2022 HCPCS Code Updates – 05.26.22
- April 2022 HCPCS Code Updates – 03.01.22
- January 2022 HCPCS Updates – New and Discontinued HCPCS Codes – 11.29.21
- July 2021 HCPCS Updates – New HCPCS Codes – 08.26.21
- July 2021 HCPCS Updates – New HCPCS Codes – 08.26.21
- April 2021 HCPCS Updates – New and Discontinued HCPCS Codes – 08.26.21