Policy No: 118
Originally Created: 08/01/2014
Last Reviewed: 05/01/2018
Last Revised: 05/01/2018
This policy applies only to physicians and other qualified healthcare professionals.
Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) are classified by the Centers for Medicare & Medicaid (CMS) into 10 categories below:
|•||IN||Inexpensive and Other Routinely Purchased Items|
|•||FS||Frequently Serviced Items|
|•||CR||Capped Rental Items|
|•||OX||Oxygen and Oxygen Equipment|
|•||OS||Ostomy, Tracheostomy & Urological Items|
|•||PO||Prosthetics & Orthotics|
|•||TE||Transcutaneous Electrical Nerve Stimulators|
|•||IL||Intra Ocular Lens|
|•||SC||Spliting and Casting|
Medicare Advantage reimbursement of DMEPOS codes will be at the lesser of billed charges or 100% of current DMEPOS fee schedule amount published by CMS.
Parenteral and Enteral Nutrition (PEN) codes will be reimbursed at the lesser of billed charges or 80% of the current DMEPOS fee schedule published by CMS.
Our health plan reserves the right to set a fee schedule amount for a DMEPOS code which is different from the amount published in the CMS DMEPOS fee schedule. For codes which do not have CMS fees, we may assign a payment rate that is a fee schedule amount or a percentage of billed charges.
Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.