Fri, 9 May 2008 09:46:13 -0400
NHIC, Corp.DME MAC A ListServe
For Immediate Release
May 07, 2008
Repairs and Replacement for Beneficiary Owned EquipmentRepairs
To repair means to fix or mend and to put the equipment back in good=
condition after damage or wear. Repairs to medically necessary beneficiary=
owned equipment may be covered up to the cost of replacement when necessary=
to make the equipment serviceable. If the expense for repairs exceeds the=
estimated expense of purchasing or renting another item of equipment for=
the remaining period of medical need, no payment can be made for the amount=
of the excess. Since renters of equipment recover from the rental charge=
the expenses they incur in maintaining the equipment they rent out,=
separately itemized charges for repair of rented equipment are not covered.=
This includes items in the frequent and substantial servicing, oxygen=
equipment, capped rental and inexpensive or routinely purchased payment=
categories during a rental period. A new Certificate of Medical Necessity=
(CMN) and/or physician's order is not needed for repairs to an=
item.Replacements
Replacement refers to the provision of an identical or nearly identical=
item. Situations involving the provision of a different item because of a=
change in medical condition are not addressed in this document. Replacement=
of DME may occur in cases of loss, irreparable damage or irreparable=
wear.Irreparable Damage
Irreparable damage is considered to mean that the damage has been caused by=
a specific accident (such as a wheelchair falling from a vehicle) or=
natural disaster (such as a fire or flood). In cases where loss or=
irreparable damage has occurred, replacement may be reimbursed. A=
physician's order and/or a new CMN is needed to reaffirm the medical=
necessity of the item. This rule applies to both beneficiary owned=
equipment and capped rental equipment.Irreparable Wear
Irreparable wear refers to deterioration sustained from day-to-day usage=
over time and a specific event cannot be identified. In cases involving=
irreparable wear, the useful lifetime of the equipment, which is 5 years,=
is taken into consideration, and in no case can it be less than 5 years. If=
the item of equipment has been in continuous use for the equipment's useful=
lifetime and irreparable wear is involved, Medicare may cover a new piece=
of equipment. A new physician's order and/or a new CMN is needed to=
reaffirm the medical necessity of the item. The replacement of a product=
before the 5-year life expectancy can only be done if the item is=
irreparably damaged, for example by a natural disaster such as fire, flood,=
etc. Replacement due to wear and tear before the 5-year lifetime is not=
covered.Note:If DME reaches its 5-year life expectancy, is in good working=
order, and meets the beneficiary's medical needs, it should not=
automatically be replaced.Billing Examples
When billing for the replacement of an accessory, there must be specific=
information notated in the NTE 2300 segment of the electronic claim in=
order for Medicare to consider coverage. This includes all of the following=
information:The description of the beneficiary owned base piece of=
equipment that the item is being replaced onThe HCPCS code of the base=
piece of equipmentThe date of purchase of the base piece of equipmentIt is=
necessary for this information to be noted only once in the NTE 2300=
segment of the electronic claim.Example: "PT owned PRIDE JAZZY610 K0011 PWC=
PUR 41603"If the claim is for replacement items and E1340 (labor) the below=
information must also be included in the NTE 2300 segment. This should also=
be notated only once on the claim.When billing code E1340, the medical=
records should contain detailed descriptions of the repairs made. All other=
required supporting medical documentation should be retained in provider=
files.Example: "RPRs to PT owned PRIDE JAZZY610 K0011 PWC PUR 41603"In=
addition to the above noted examples, each claim line for each replacement=
part must include a description of the reason why the item is being=
replaced. These details should be notated in the NTE 2400 segment of the=
electronic claim.Example: "RPL E0952 BBR" or "RPL arm pad=
destroyed"Reminders
When using the NTE segments to notate documentation, it is suggested to=
submit only the required pertinent information as noted in the above=
examples. Providers should not include any wording that does not relate to=
the items and services being billed. The note segments are limited to 80=
characters at the claim level (2300 segment) and 80 characters for each=
service line level (2400 segment). It is encouraged to utilize the DME MAC=
A "suggested list" of abbreviations at:=
http://www.medicarenhic.com/dme/ediabbrev.shtmlThis list was created for=
suppliers to use in order to maximize the effectiveness of the limited=
space in both note segments.If a claim that requires additional information=
is su
Long message truncated by MailBucket.