DME MAC JURISDICTION C - CGS

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Table of ContentsTable of Contents1. Introduction2. Provider Enrollment3. Supplier Documentation4. Certificates of Medical Necessity (CMNs)5. DMEPOS Fee Schedule6. Claim Submission7. Crossover Claims8. Electronic Data Interchange (EDI)9. Coverage and Medical Policy10. Pricing11. Coordination of Benefits (COB)12. Overpayments13. Inquiries and Appeals14. Fraud and Abuse15. Resources16. Coding17. System Outputs18 Acronyms and AbbreviationsDME MAC Jurisdiction C Supplier Manual Page 1
Chapter One √Introduction
Page 1: SUPPLIERDME MAC JURISDICTION CMANUA
Page 7: Introduction Chapter 1A Medicare ca
Page 10 and 11: Introduction Chapter 1Freedom of In
Page 12 and 13: Supplier Enrollment Chapter 2Overvi
Page 14 and 15: Supplier Enrollment Chapter 2Each D
Page 16 and 17: Supplier Enrollment Chapter 2those
Page 18 and 19: Supplier Enrollment Chapter 2Do Not
Page 20: Supplier Enrollment Chapter 2answer
Page 23 and 24: Supplier Enrollment Chapter 2Suppli
Page 25 and 26: Supplier Documentation Chapter 3Gen
Page 27 and 28: Supplier Documentation Chapter 3des
Page 29 and 30: Supplier Documentation Chapter 3K08
Page 31 and 32: Supplier Documentation Chapter 3E26
Page 33 and 34: Supplier Documentation Chapter 3Sup
Page 35 and 36: Supplier Documentation Chapter 3Med
Page 37 and 38: Supplier Documentation Chapter 3Mis
Page 39 and 40: Supplier Documentation Chapter 3tha
Page 41 and 42: Supplier Documentation Chapter 3per
Page 43 and 44: Supplier Documentation Chapter 3Exa
Page 45 and 46: Chapter Four √Certificates of Med
Page 49 and 50: CMNs Chapter 4Suppliers and physici
Page 51 and 52: CMNs Chapter 4Evidence of Medical N
Page 53 and 54:
CMNs Chapter 4blood gas study on th
Page 55 and 56:
CMNs Chapter 4The request for recer
Page 57 and 58:
CMNs Chapter 4Not all requirements
Page 59 and 60:
CMNs Chapter 4Plan, or hospice and
Page 61 and 62:
DMEPOS Fee Schedule Chapter 5DMEPOS
Page 63 and 64:
DMEPOS Fee Schedule Chapter 5Artifi
Page 65 and 66:
DMEPOS Fee Schedule Chapter 5A new
Page 67 and 68:
DMEPOS Fee Schedule Chapter 5items
Page 69 and 70:
DMEPOS Fee Schedule Chapter 5QE Use
Page 71 and 72:
DMEPOS Fee Schedule Chapter 54. Own
Page 73 and 74:
DMEPOS Fee Schedule Chapter 5lifeti
Page 75 and 76:
DMEPOS Fee Schedule Chapter 5For ca
Page 77 and 78:
DMEPOS Fee Schedule Chapter 58. The
Page 79 and 80:
Claim Submission Chapter 6Mandatory
Page 81 and 82:
Claim Submission Chapter 6Suppliers
Page 83 and 84:
Claim Submission Chapter 6addition
Page 85 and 86:
Claim Submission Chapter 6upgrade.
Page 87 and 88:
Claim Submission Chapter 654 Interm
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Claim Submission Chapter 6to defaul
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Claim Submission Chapter 6in the NA
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Claim Submission Chapter 6NOTE: Thi
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Claim Submission Chapter 6Item 17b
Page 97 and 98:
Claim Submission Chapter 6When a ph
Page 99 and 100:
Claim Submission Chapter 6• Simpl
Page 101 and 102:
Claim Submission Chapter 6Beneficia
Page 103 and 104:
Claim Submission Chapter 6The diffe
Page 105 and 106:
Chapter Seven √Crossover Claims
Page 107 and 108:
Crossover Claims Chapter 7• The w
Page 109 and 110:
Chapter Eight √Electronic Data In
Page 111 and 112:
Electronic Data Interchange (EDI) C
Page 113 and 114:
Electronic Data Interchange (EDI) C
Page 115 and 116:
Coverage and Medical Policy Chapter
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Pricing Chapter 10PricingThe Medica
Page 127 and 128:
Pricing Chapter 102006, is arrayed
Page 129 and 130:
Pricing Chapter 10equipment that we
Page 131 and 132:
Coordination of Benefits Chapter 11
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Chapter Twelve √Overpayments
Page 145 and 146:
Overpayments and Refunds Chapter 12
Page 147 and 148:
Overpayments and Refunds Chapter 12
Page 149 and 150:
Inquiries and Appeals Chapter 13Tel
Page 151 and 152:
Inquiries and Appeals Chapter 13In
Page 153 and 154:
Inquiries and Appeals Chapter 13(Ju
Page 155 and 156:
Inquiries and Appeals Chapter 13Add
Page 157 and 158:
Inquiries and Appeals Chapter 13Cle
Page 159 and 160:
Chapter Fourteen √Fraud and Abuse
Page 161 and 162:
Fraud and Abuse Chapter 14pre- and
Page 163 and 164:
Fraud and Abuse Chapter 14Abuse tak
Page 165 and 166:
Fraud and Abuse Chapter 14Protect Y
Page 167 and 168:
Resources Chapter 15ResourcesThe fo
Page 169 and 170:
Resources Chapter 15Advance Determi
Page 171 and 172:
Resources Chapter 15The supplier en
Page 173 and 174:
Resources Chapter 15Medicare Covera
Page 175 and 176:
Coding Chapter 16The Statistical An
Page 177 and 178:
Coding Chapter 161/1/2003)BO Orally
Page 179 and 180:
Coding Chapter 16KNKOKPKQKRKSKTRepl
Page 181 and 182:
Chapter Seventeen √Symptoms Outpu
Page 183 and 184:
System Outputs Chapter 17the remit.
Page 185 and 186:
System Outputs Chapter 171003 INV P
Page 187 and 188:
Chapter Eighteen √Acronyms and Ab
Page 189 and 190:
Acronyms and Abbreviations Chapter
Page 191 and 192:
HCPCSAppendix ALevel II HCPCS Codes
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HCPCSAppendix AA4236 Replacement ba
Page 195 and 196:
HCPCSAppendix AA4332 Lubricant, ind
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HCPCSAppendix A(Eff. Date 1/1/2000)
Page 199 and 200:
HCPCSAppendix AA4423 Ostomy pouch,
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HCPCSAppendix A1/1/2003) (Deleted e
Page 203 and 204:
HCPCSAppendix A11/1/1996)A4631 Repl
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HCPCSAppendix Adialysis (Eff. Date
Page 207 and 208:
HCPCSAppendix AA4930 Gloves, steril
Page 209 and 210:
HCPCSAppendix Ashoe (Eff. Date 1/1/
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HCPCSAppendix AdressingA6218 Gauze,
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HCPCSAppendix AA6257 Transparent fi
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HCPCSAppendix AA6445 Conforming ban
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HCPCSAppendix AA7037 Tubing used wi
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HCPCSAppendix A(Deleted eff. 12/31/
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HCPCSAppendix AB4104 Additive for e
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HCPCSAppendix AB4199 Parenteral nut
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HCPCSAppendix ADate 1/1/2004)E0141
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HCPCSAppendix AE0197 Air pressure p
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HCPCSAppendix AE0292 Hospital bed,
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HCPCSAppendix AE0443 Portable oxyge
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HCPCSAppendix AE0575 Nebulizer; ult
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HCPCSAppendix AE0668 Segmental pneu
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HCPCSAppendix AE0783 Infusion pump
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HCPCSAppendix A1/1/2003)E0972 Wheel
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HCPCSAppendix AE1038 Transport chai
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HCPCSAppendix AE1550 Bath conductiv
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HCPCSAppendix AALL COMPONENTS AND A
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HCPCSAppendix Aattaching hardware (
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HCPCSAppendix A1/1/2004)E2367 Power
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HCPCSAppendix AE2506 Speech generat
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HCPCSAppendix AHCPCS GPayment Categ
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HCPCSAppendix AJ0215 Injection, ale
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HCPCSAppendix AJ0630 Injection, cal
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HCPCSAppendix AJ1055 Injection, med
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HCPCSAppendix AJ1510 Injection, gam
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HCPCSAppendix AJ1750 Injection, iro
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HCPCSAppendix AJ2300 Injection, nal
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HCPCSAppendix AJ2730 Injection, pra
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HCPCSAppendix AJ3246 Injection, Tir
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HCPCSAppendix AJ7110 Infusion, dext
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HCPCSAppendix ABioengineered or pro
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HCPCSAppendix A(Terminated on 6/30/
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HCPCSAppendix AJ7644 Ipratropium br
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HCPCSAppendix AJ8498 Antiemetic dru
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HCPCSAppendix AJ9182 Etoposide, 100
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HCPCSAppendix AHCPCS KPayment Categ
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HCPCSAppendix AK0040 Adjustable ang
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HCPCSAppendix AK0088 Battery charge
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HCPCSAppendix AK0132 Male external
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HCPCSAppendix AK0182 Water, distill
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HCPCSAppendix AK0222 Gauze, impregn
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HCPCSAppendix A12/31/1996)K0260 Wou
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HCPCSAppendix AK0412 Mycophenolate
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HCPCSAppendix AK0450 Adhesive, liqu
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HCPCSAppendix AK0530 Nebulizer, dur
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HCPCSAppendix AK0559 Addition to lo
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HCPCSAppendix AK0595 Ostomy pouch,
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HCPCSAppendix AK0627 Traction equip
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HCPCSAppendix AK0643 Lumbar-sacral
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HCPCSAppendix AK0664 Positioning wh
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HCPCSAppendix AK0827 Power wheelcha
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HCPCSAppendix AK0868 Power wheelcha
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HCPCSAppendix AL0200 Cervical, mult
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HCPCSAppendix AL0462 TLSO, triplana
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HCPCSAppendix AL0490 TLSO, sagittal
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HCPCSAppendix AL0627 Lumbar orthosi
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HCPCSAppendix AT-9 vertebra, latera
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HCPCSAppendix AL1040 Addition to CT
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HCPCSAppendix AL1815 Knee orthosis,
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HCPCSAppendix AL1970 Ankle-foot ort
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HCPCSAppendix AL2136 Knee-ankle-foo
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HCPCSAppendix AL2520 Addition to lo
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HCPCSAppendix AL3031 Foot, insert/p
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HCPCSAppendix AL3360 Sole wedge, ou
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HCPCSAppendix A(e.g., neoprene, lyc
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HCPCSAppendix AL3906 Wrist hand ort
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HCPCSAppendix AL3938 Wrist hand fin
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HCPCSAppendix AL3978 Shoulder elbow
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HCPCSAppendix AL5100 Below knee, mo
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HCPCSAppendix AL5580 Preparatory, a
Page 355 and 356:
HCPCSAppendix AL5660 Addition to lo
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HCPCSAppendix AL5702 Replacement, s
Page 359 and 360:
HCPCSAppendix AL5855 Addition, endo
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HCPCSAppendix AL6025 Transcarpal/me
Page 363 and 364:
HCPCSAppendix AL6615 Upper extremit
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Page 367 and 368:
HCPCSAppendix AL6860 Terminal devic
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HCPCSAppendix AL7007 Electric hand,
Page 371 and 372:
HCPCSAppendix AL7611 TERMINAL DEVIC
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HCPCSAppendix A12/31/2005)L8230 Gra
Page 375 and 376:
HCPCSAppendix AL8640 Patella implan
Page 377 and 378:
HCPCSAppendix AQ0168 Dronabinol, 5
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HCPCSAppendix AQ4075 Injection, acy
Page 381 and 382:
HCPCSAppendix AHCPCS VPayment Categ
Page 383 and 384:
HCPCSAppendix AV2211 Spherocylinder
Page 385 and 386:
HCPCSAppendix AV2531 Contact lens,
Page 387:
HCPCSAppendix AV5070 Glasses, air c
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DME MAC JURISDICTION C - CGS

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