October 27, 2022
DMEPOS HCPCS Code Jurisdiction List - October 2022 Update
NOTE: Deleted codes are valid for dates of service on or before the date of deletion.
NOTE: Updated codes are in bold.
NOTE: The jurisdiction list includes codes that are not payable by Medicare. Please consult the Medicare contractor in whose jurisdiction a claim would be filed in order to determine coverage under Medicare.
NOTE: All HCPCs code listed have DME or joint MAC Jurisdiction. Any other codes not listed as DME MAC only or dual DME MAC/Part B MAC jurisdiction shall be considered to be A/B MAC (Part B) only jurisdiction.
HCPCS | DESCRIPTION | JURISDICTION | COMMENT |
---|---|---|---|
A4206 - A4209 | Medical, Surgical, and Self- | Part B MAC if incident to a physician's | |
Administered Injection | service (not separately payable). If other, | ||
Supplies | DME MAC. | ||
A4210 | Needle Free Injection Device | DME MAC | |
A4211 | Medical, Surgical, and Self- | Part B MAC if incident to a physician's | |
Administered Injection | service (not separately payable). If other, | ||
Supplies | DME MAC. | ||
A4213 - A4215 | Medical , Surgical, and Self- | Part B MAC if incident to a physician's | |
Administered Injection Supplies | service (not separately payable). If other, | ||
DME MAC. | |||
A4216 - A4218 | Saline | Part B MAC if incident to a physician's | |
service (not separately payable). If other, | |||
DME MAC. | |||
A4221 - A4238 | Self-Administered Injection | DME MAC | |
and Diabetic Supplies | |||
A4244 - A4250 | Medical, Surgical, and Self- | Part B MAC if incident to a physician's | |
Administered Injection Supplies | service (not separately payable). If other, | ||
DME MAC. | |||
A4252 - A4259 | Diabetic Supplies | DME MAC | |
A4265 | Paraffin | Part B MAC if incident to a physician's | |
service (not separately payable). If other, | |||
DME MAC. | |||
A4280 | Accessory for Breast Prosthesis | DME MAC | |
A4281 - A4286 | Accessory for Breast Pump | DME MAC | |
A4305 - A4306 | Disposable Drug Delivery | Part B MAC if incident to a physician's | |
System | service (not separately payable). If other, | ||
DME MAC. | |||
A4310 - A4358 | Incontinence Supplies/ | If provided in the physician's office for a | |
Urinary Supplies | temporary condition, the item is incident to | ||
the physician's service & billed to the Part B MAC. | |||
If provided in the physician's office | |||
or other place of service for a permanent | |||
condition, the item is a prosthetic device & | |||
billed to the DME MAC. | |||
A4360 - A4437 | Urinary Supplies | If provided in the physician's office for a | |
temporary condition, the item is incident to the | |||
physician's service & billed to the Part B MAC. | |||
If provided in the physician's office | |||
or other place of service for a permanent | |||
condition, the item is a prosthetic device & | |||
billed to the DME MAC. | |||
A4450 - A4452 | Tape; Adhesive Remover | Part B MAC if incident to a physician's | |
service (not separately payable), or if supply for implanted prosthetic device. If other, | |||
DME MAC. | |||
A4453 | Enema Catheter | DME MAC | |
A4455 - A4456 | Tape; Adhesive Remover | Part B MAC if incident to a physician's | |
service (not separately payable), or if supply for implanted prosthetic device. If other, | |||
DME MAC. | |||
A4458-A4459 | Enema Bag/System | DME MAC | |
A4461-A4463 | Surgical Dressing Holders | Part B MAC if incident to a physician's | |
service (not separately payable). If other, | |||
DME MAC. | |||
A4465 - A4467 | Non-elastic Binder and Garment, Strap, Covering | DME MAC | |
A4481 | Tracheostomy Supply | Part B MAC if incident to a physician's | |
service (not separately payable). If other, | |||
DME MAC. | |||
A4483 | Moisture Exchanger | DME MAC | |
A4490 - A4510 | Surgical Stockings | DME MAC | |
A4520 | Diapers | DME MAC | |
A4553 - A4554 | Underpads | DME MAC | |
A4555 - A4558 | Electrodes; Lead Wires; Conductive Paste | Part B MAC if incident to a physician's | |
service (not separately payable). If other, | |||
DME MAC. | |||
A4559 | Coupling Gel | Part B MAC if incident to a physician's service | |
(not separately payable). If other, DME MAC. | |||
A4575 | Topical Hyperbaric Oxygen | DME MAC | |
Chamber, Disposable | |||
A4595 | TENS Supplies | Part B MAC if incident to a physician's | |
service (not separately payable). If other, | |||
DME MAC. | |||
A4596 | Electrical Stimulator Supplies | DME MAC | |
A4600 | Sleeve for Intermittent Limb | DME MAC | |
Compression Device | |||
A4601-A4602 | Lithium Replacement Batteries | DME MAC | |
A4604 | Tubing for Positive Airway Pressure | DME MAC | |
Device | |||
A4605 | Tracheal Suction Catheter | DME MAC | |
A4606 | Oxygen Probe for Oximeter | DME MAC | |
A4608 | Transtracheal Oxygen Catheter | DME MAC | |
A4611 - A4613 | Oxygen Equipment Batteries and | DME MAC | |
Supplies | |||
A4614 | Peak Flow Rate Meter | Part B MAC if incident to a physician's | |
service (not separately payable). If other, | |||
DME MAC. | |||
A4615 - A4629 | Oxygen & Tracheostomy Supplies | Part B MAC if incident to a physician's | |
service (not separately payable). If other, | |||
DME MAC. | |||
A4630 - A4640 | DME Supplies | DME MAC | |
A4649 | Miscellaneous Surgical Supplies | Part B MAC if incident to a physician's | |
service (not separately payable), or if supply | |||
for implanted prosthetic device or implanted | |||
DME. If other, DME MAC. | |||
A4651 - A4932 | Supplies for ESRD | DME MAC (not separately payable) | |
A5051 - A5093 | Additional Ostomy Supplies | If provided in the physician's office for a | |
temporary condition, the item is incident to the | |||
physician's service & billed to the Part B MAC. | |||
If provided in the physician's office | |||
or other place of service for a permanent | |||
condition, the item is a prosthetic device & | |||
billed to the DME MAC. | |||
A5102 - A5200 | Additional Incontinence and | If provided in the physician's office for a | |
Ostomy Supplies | temporary condition, the item is incident to the | ||
physician's service & billed to the Part B MAC. | |||
If provided in the physician's office | |||
or other place of service for a permanent | |||
condition, the item is a prosthetic device & | |||
billed to the DME MAC. | |||
A5500 - A5514 | Therapeutic Shoes | DME MAC | |
A6000 | Non-Contact Wound Warming | DME MAC | |
Cover | |||
A6010-A6024 | Surgical Dressing | Part B MAC if incident to a physician's | |
service (not separately payable) or if supply | |||
for implanted prosthetic device or implanted | |||
DME. If other, DME MAC. | |||
A6025 | Silicone Gel Sheet | Part B MAC if incident to a physician's | |
service (not separately payable) or if supply | |||
for implanted prosthetic device or implanted | |||
DME. If other, DME MAC. | |||
A6154 - A6411 | Surgical Dressing | Part B MAC if incident to a physician's | |
service (not separately payable) or if supply | |||
for implanted prosthetic device or implanted | |||
DME. If other, DME MAC. | |||
A6412 | Eye Patch | Part B MAC if incident to a physician's | |
service (not separately payable) or if supply | |||
for implanted prosthetic device or implanted | |||
DME. If other, DME MAC. | |||
A6413 | Adhesive Bandage | Part B MAC if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. | |
A6441 - A6457 | Surgical Dressings | Part B MAC if incident to a physician's | |
service (not separately payable), or if supply | |||
for implanted prosthetic device or implanted | |||
DME. If other, DME MAC. | |||
A6501-A6512 | Surgical Dressing | Part B MAC if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC |
|
A6513 | Compression Burn Mask | DME MAC | |
A6530 - A6549 | Compression Gradient Stockings | DME MAC | |
A6550 | Supplies for Negative Pressure | DME MAC | |
Wound Therapy Electrical Pump | |||
A7000 - A7002 | Accessories for Suction Pumps | DME MAC | |
A7003 - A7039 | Accessories for Nebulizers, | DME MAC | |
Aspirators and Ventilators | |||
A7044 - A7047 | Respiratory Accessories | DME MAC | |
A7501-A7527 | Tracheostomy Supplies | DME MAC | |
A8000-A8004 | Protective Helmets | DME MAC | |
A9270 | Noncovered Items or Services | DME MAC | |
A9272 | Disposable Wound Suction Pump | DME MAC | |
A9273 | Hot Water Bottles, Ice Caps or Collars, and Heat and/or Cold Wraps | DME MAC | |
A9274 - A9275 | Glucose Monitoring | DME MAC | A9276-A9278 made invalid for Medicare 4/1/22 |
A9279 | Monitoring Feature/Device | DME MAC | |
A9280 | Alarm Device | DME MAC | |
A9281 | Reaching/Grabbing Device | DME MAC | |
A9282 | Wig | DME MAC | |
A9283 | Foot Off Loading Device | DME MAC | |
A9284- A9286 | Non-electric Spirometer, Inversion | DME MAC | |
Devices and Hygienic Items | |||
A9291 has been removed from this list as it is Part B MAC only Jurisdiction | |||
A9300 | Exercise Equipment | DME MAC | |
A9900 | Miscellaneous DME Supply or | Part B MAC if used with implanted DME. If | |
Accessory | other, DME MAC. | ||
A9901 | Delivery | DME MAC | |
A9999 | Miscellaneous DME Supply or | Part B MAC if used with implanted DME. If | |
Accessory | other, DME MAC. | ||
B4034 - B9999 | Enteral and Parenteral Therapy | DME MAC | |
E0100 - E0105 | Canes | DME MAC | |
E0110 - E0118 | Crutches | DME MAC | |
E0130 - E0159 | Walkers | DME MAC | |
E0160 - E0175 | Commodes | DME MAC | |
E0181 - E0199 | Decubitus Care Equipment | DME MAC | |
E0200 - E0239 | Heat/Cold Applications | DME MAC | |
E0240 - E0248 | Bath and Toilet Aids | DME MAC | |
E0249 | Pad for Heating Unit | DME MAC | |
E0250 - E0304 | Hospital Beds | DME MAC | |
E0305 - E0326 | Hospital Bed Accessories | DME MAC | |
E0328 - E0329 | Pediatric Hospital Beds | DME MAC | |
E0350 - E0352 | Electronic Bowel Irrigation System | DME MAC | |
E0370 | Heel Pad | DME MAC | |
E0371 - E0373 | Decubitus Care Equipment | DME MAC | |
E0424 - E0484 | Oxygen and Related Respiratory | DME MAC | |
Equipment | |||
E0485 - E0486 | Oral Device to Reduce Airway | DME MAC | |
Collapsibility | |||
E0487 | Electric Spirometer | DME MAC | |
E0500 | IPPB Machine | DME MAC | |
E0550 - E0585 | Compressors/Nebulizers | DME MAC | |
E0600 | Suction Pump | DME MAC | |
E0601 | CPAP Device | DME MAC | |
E0602 - E0604 | Breast Pump | DME MAC | |
E0605 | Vaporizer | DME MAC | |
E0606 | Drainage Board | DME MAC | |
E0607 | Home Blood Glucose Monitor | DME MAC | |
E0610 - E0615 | Pacemaker Monitor | DME MAC | |
E0617 | External Defibrillator | DME MAC | |
E0618 - E0619 | Apnea Monitor | DME MAC | |
E0620 | Skin Piercing Device | DME MAC | |
E0621 - E0636 | Patient Lifts | DME MAC | |
E0637 - E0642 | Standing Devices/Lifts | DME MAC | |
E0650 - E0676 | Pneumatic Compressor and | DME MAC | |
Appliances | |||
E0691 - E0694 | Ultraviolet Light Therapy Systems | DME MAC | |
E0700 | Safety Equipment | DME MAC | |
E0705 | Transfer Board | DME MAC | |
E0710 | Restraints | DME MAC | |
E0720 - E0745 | Electrical Nerve Stimulators | DME MAC | |
E0747 - E0748 | Osteogenic Stimulators | DME MAC | |
E0755- E0770 | Stimulation Devices | DME MAC | |
E0776 | IV Pole | DME MAC | |
E0779 - E0780 | External Infusion Pumps | DME MAC | |
E0781 | Ambulatory Infusion Pump | DME MAC | |
E0784 | Infusion Pumps, Insulin | DME MAC | |
E0791 | Parenteral Infusion Pump | DME MAC | |
E0830 | Ambulatory Traction Device | DME MAC | |
E0840 - E0900 | Traction Equipment | DME MAC | |
E0910 - E0930 | Trapeze/Fracture Frame | DME MAC | |
E0935 - E0936 | Passive Motion Exercise Device | DME MAC | |
E0940 | Trapeze Equipment | DME MAC | |
E0941 | Traction Equipment | DME MAC | |
E0942 - E0945 | Orthopedic Devices | DME MAC | |
E0946 - E0948 | Fracture Frame | DME MAC | |
E0950 - E1298 | Wheelchairs | DME MAC | |
E1300 - E1310 | Whirlpool Equipment | DME MAC | |
E1352 - E1392 | Additional Oxygen Related | DME MAC | |
Equipment | |||
E1399 | Miscellaneous DME | Part B MAC if implanted DME. If other, DME | |
MAC. | |||
E1405 - E1406 | Additional Oxygen Equipment | DME MAC | |
E1500 - E1625 | Artificial Kidney Machines and | DME MAC (not separately payable) | |
Accessories | |||
E1630 -E1699 | Artificial Kidney Machines and | DME MAC (not separately payable) | |
Accessories | |||
E1700 - E1702 | TMJ Device and Supplies | DME MAC | |
E1800 - E1841 | Dynamic Flexion Devices | DME MAC | |
E1902 | Communication Board | DME MAC | |
E2000 | Gastric Suction Pump | DME MAC | |
E2100 - E2102 | Blood Glucose Monitors with special Features: Continuous Glucose Monitor | DME MAC | |
E2120 | Pulse Generator for Tympanic Treatment of Inner Ear | DME MAC | |
E2201 - E2398 | Wheelchair Accessories | DME MAC | |
E2402 | Negative Pressure Wound | DME MAC | |
Therapy Pump | |||
E2500 - E2599 | Speech Generating Device | DME MAC | |
E2601 - E2633 | Wheelchair Cushions and Accessories | DME MAC | |
E8000 - E8002 | Gait Trainers | DME MAC | |
G0333 | Dispensing Fee | DME MAC | |
J0120 - J1094 | Injection | Part B MAC if incident to a physician's | |
service or used in an implanted infusion pump. | |||
If other, DME MAC. | |||
J1100-J2786 | Injection | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J2788-J3570 | Injection | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J7030 - J7131 | Miscellaneous Drugs and | Part B MAC if incident to a physician's | |
Solutions | service or used in an implanted infusion pump. | ||
If other, DME MAC. | |||
J7340 | Carbidopa/Levodopa | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J7500 - J7599 | Immunosuppressive Drugs | Part B MAC if incident to a physician's | |
service or used in an implanted infusion pump. | |||
If other, DME MAC. | |||
J7604 - J7699 | Inhalation Solutions | Part B MAC if incident to a physician's | |
service. If other, DME MAC. | |||
J7799 -J7999 | NOC Drugs, Other than | Part B MAC if incident to a physician's | |
Inhalation Drugs | service or used in an implanted infusion pump. If other, DME MAC. | ||
J8498 | Anti-emetic Drug | DME MAC | |
J8499 | Prescription Drug, Oral, Non | Part B MAC if incident to a physician's | |
Chemotherapeutic | service. If other, DME MAC. | ||
J8501 - J8999 | Oral Anti-Cancer Drugs | DME MAC | |
J9000 - J9999 | Chemotherapy Drugs | Part B MAC if incident to a physician's | |
service or used in an implanted infusion pump. | |||
If other, DME MAC. | |||
K0001 - K0108 | Wheelchairs | DME MAC | |
K0195 | Elevating Leg Rests | DME MAC | |
K0455 | Infusion Pump used for | DME MAC | |
Uninterrupted Administration of | |||
Epoprostenol | |||
K0462 | Loaner Equipment | DME MAC | |
K0552 - K0605 | External Infusion Pump Supplies & Continuous Glucose Monitor |
DME MAC | |
K0606 - K0609 | Defibrillator Accessories | DME MAC | |
K0669 | Wheelchair Cushion | DME MAC | |
K0672 | Soft Interface for Orthosis | DME MAC | |
K0730 | Inhalation Drug Delivery System | DME MAC | |
K0733 | Power Wheelchair Accessory | DME MAC | |
K0738 | Oxygen Equipment | DME MAC | |
K0739 | Repair or Nonroutine Service for DME | Part B MAC if implanted DME. If other, DME MAC | |
K0740 | Repair or Nonroutine Service for Oxygen Equipment | DME MAC | |
K0743 - K0746 | Suction Pump and Dressings | DME MAC | |
K0800 - K0899 | Power Mobility Devices | DME MAC | |
K0900 | Custom DME, other than Wheelchair | DME MAC | |
K1001- K1003 | Devices | DME MAC | |
K1004 | Devices | DME MAC when the supplier considers the item DMEPOS. Part B MAC if the supplier considers the item something other than DMEPOS (e.g., supplies furnished incident to the professional service of a physician) | |
K1005- K1006 | Devices | DME MAC | |
K1007 | Devices | DME MAC when the supplier considers the item DMEPOS. Part B MAC if the supplier considers the item something other than DMEPOS (e.g., supplies furnished incident to the professional service of a physician) | |
K1009 | Devices | DME MAC | |
K1013 | Devices | Part B MAC if a supply for or inserted by a licensed healthcare provider. If other, DME MAC | |
K1014-K1026 | Devices | DME MAC | |
K1027 | Devices | DME MAC when the supplier considers the item DMEPOS. Part B MAC if the supplier considers the item something other than DMEPOS (e.g., supplies furnished incident to the professional service of a physician) | |
K1028-K1029 | Devices | DME MAC | |
K1031-K1033 | Devices | DME MAC | |
L0112 - L4631 | Orthotics & Devices | DME MAC | |
L5000 - L5999 | Lower Limb Prosthetics | DME MAC | |
L6000 - L7499 | Upper Limb Prosthetics | DME MAC | |
L7510 - L7520 | Repair of Prosthetic Device | Part B MAC if repair of implanted prosthetic | |
device. If other, DME MAC. | |||
L7600 - L8485 | Prosthetics | DME MAC | |
L8499 | Unlisted Procedure for | Part B MAC if implanted prosthetic device. | |
Miscellaneous Prosthetic Services | If other, DME MAC. | ||
L8500 - L8501 | Artificial Larynx; Tracheostomy | DME MAC | |
Speaking Valve | |||
L8505 | Artificial Larynx Accessory | DME MAC | |
L8507 | Voice Prosthesis, Patient Inserted | DME MAC | |
L8509 | Voice Prosthesis, Inserted by a Licensed Health Care Provider | Part B MAC for dates of service on or after 10/01/2010. DME MAC for dates of service prior to 10/01/2010 | |
L8510 | Voice Prosthesis | DME MAC | |
L8511 - L8515 | Voice Prosthesis | Part B MAC if used with tracheoesophageal voice prostheses inserted by a licensed health care provider. If other, DME MAC | |
L8701-L8702 | Assist Device | DME MAC | |
L9900 | Miscellaneous Orthotic or | Part B MAC if used with implanted prosthetic | |
Prosthetic Component or | device. If other, DME MAC. | ||
Accessory | |||
Q0144 | Azithromycin Dihydrate | Part B MAC if incident to a physician's | |
service. If other, DME MAC. | |||
Q0161 - Q0181 | Anti-emetic | DME MAC | |
Q0510 - Q0514 | Drug Dispensing Fees | DME MAC | |
Q2049-Q2050 | Doxorubicin | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
Q2052 | IVIG Demonstration | DME MAC | |
Q4074 | Inhalation Drug | Part B MAC if incident to a physician's | |
service. If other, DME MAC. | |||
Q5101-Q5121 | Injection | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
Q9991-Q9992 | Injection | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
V2020 - V2025 | Frames | DME MAC | |
V2100 - V2513 | Lenses | DME MAC | |
V2520 - V2523 | Hydrophilic Contact Lenses | Part B MAC if incident to a physician's | |
service. If other, DME MAC. | |||
V2524- V2525 | Hydrophilic Contact Lenses | DME MAC | |
V2530 - V2531 | Contact Lenses, Scleral | DME MAC | |
V2599 | Contact Lens, Other Type | Part B MAC if incident to a physician's | |
service. If other, DME MAC. | |||
V2600 - V2615 | Low Vision Aids | DME MAC | |
V2623 - V2629 | Prosthetic Eyes | DME MAC | |
V2700 - V2780 | Miscellaneous Vision Service | DME MAC | |
V2781 | Progressive Lens | DME MAC | |
V2782 - V2784 | Lenses | DME MAC | |
V2786 | Lens | DME MAC | |
V2797 | Vision Supply | DME MAC | |
V2799 | Miscellaneous Vision Service | Part B MAC if supply for an implanted prosthetic device. If other, DME MAC |
|
V5336 | Repair/Modification of | DME MAC | |
Augmentative Communicative | |||
System or Device |