What Is DME Billing?

DME (durable medical equipment) billing defines charges for the use of medical equipment and supplies. The Healthcare Common Procedure Coding System has established level II codes to designate and classify equipment and supplies.

Coding System

• The HCPCS level II scheme is accepted and used for billing and claim purposes by both public (Medicare & Medicaid) and private insurers (Exclusive Provider Organizations, Health Maintenance Organizations, Point of Service Plans) carriers.

Identification

• According to the American Physical Therapy Association's "FAQs Regarding Billing for DME, Orthotics, And Prosthetics," DME must meet the criteria put forth by insurance providers. This includes items that can withstand repeated use, serve a direct medical purpose and are appropriate for home usage.

Considerations

• When DME is prescribed by a physician, deemed medically necessary and obtained through an accepted supplier/provider, a patient's insurance carrier may cover all or part of the equipment's cost.

Billing Process

• The prescribing physician or patient contacts the certified supplier with the insurance information and equipment order. With the exception of implanted equipment, DME suppliers and providers must bill the Durable Medical Equipment Regional Carrier (DMERC), using the billing number assigned to them by the National Supplier Clearinghouse (NSC).