Corporate

March 5, 2014 - Revised: 05.24.16

Supplies and Durable Medical Equipment (DME): Which Contractor Processes the Claim?

Some supplies and durable medical equipment (DME) are handled by the A/B Medicare Administrative Contractor (MAC); in other cases, these items must be submitted to the DME MAC.

Jurisdiction in a nutshell:

In general, if the claim is for: Submit to:
Non-implanted DME or related equipment DME MAC
Prosthetic
Orthotic
Supply that is "incident to" a physician's service A/B MAC (CGS)
Implanted DME or related equipment

Common mistakes

CGS, as the Jurisdiction 15 A/B MAC, frequently receives claims for the following supplies. These supplies must be submitted to the DME MAC. If you submit them to CGS, they will be rejected (returned as unprocessable) with remark codes MA130 and CO-109. Examples include:

  • HCPCS codes A4213-A4215 and A4220-A4250: medical, surgical, and self-administered injection supplies
  • HCPCS codes A4216-A4218: saline
  • HCPCS codes A6441-A6512: surgical dressings

Preventing denials

  • Check the 2016 Jurisdiction List for DMEPOS HCPCS CodesPDF for your date of service on the CMS website before submitting your claim (files are located under Coding).
  • Be aware: some supplies that are submitted to A/B MACs are designated in the CMS Medicare Physician Fee Schedule Database as bundled, excluded, or invalid. This means that, although the supplies are in the jurisdiction of the A/B MAC for claim submission purposes, they are not separately payable under Medicare Part B. Refer to the CGS special edition MPFS publication for more information.
    • Example: surgical trays (HCPCS code A4550) are "local carrier jurisdiction," so claims for these supplies would be submitted to CGS. HCPCS code A4550 is listed as status B in the Medicare Physician Fee Schedule Database, however, which means payment for this code is always included in payment for other services.

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