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

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

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March 4, 2024

Billing Repairs of DMEPOS Items Reminder

The DME MAC Jurisdiction C 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 C 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 C 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.