Items dispensed and/or billed that do not meet these order/prescription requirements and those below must be submitted with an EY modifier added to each affected HCPCS code.Ĭertain items require an order based on statute (e.g., therapeutic shoes for diabetics, oral anticancer drugs, and oral antiemetic drugs which are a replacement for intravenous antiemetic drugs). The order/prescription shall be kept on file and made available upon request. The name and National Provider Identifier (NPI) of the treating practitioner on the order/prescription for the item or service shall be used on the claim submitted to the DME MAC. The term “treating practitioner” is used throughout this document and except where specifically noted, refers to physician, as defined in section 1861(r)(1) of the Act, or physician assistant, nurse practitioner, or clinical nurse specialist, as those terms are defined in section 1861(aa)(5) of the Act. “All claims” refers to all claims submitted for payment of purchases or rentals to Medicare Part B. This written order/prescription is referred to as the Standard Written Order (SWO) (see below). Where there are differences between the policies and this article, this document shall take precedence.Īll claims for items billed to Medicare require a written order/prescription from the treating practitioner as a condition for payment. Note: The information in this document supersedes the material currently contained in all LCDs and related policy articles. It is important that suppliers review the actual LCD, the related Policy Article, and the Standard Documentation Requirements (SDR) article to be sure to have all of the relevant information necessary and applicable to the item(s) provided. This article sets out the general requirements that are applicable to all DMEPOS claims submitted to the DME MACs.ĭocumentation must be maintained in the supplier's files for seven (7) years from date of service (DOS).Īll Policy Specific Documentation Requirements are located in the LCD-related Policy Article, which is linked to the applicable LCD. #Aspx file viewer for mac code#The documentation requirements are compiled from Statutes, Code of Federal Regulations, Centers for Medicare and Medicaid Services (CMS) National Coverage Determinations (NCDs), CMS rulings and sub-regulatory guidance (CMS manuals), and DME MAC publications. Consequently, the Durable Medical Equipment Medicare Administrative Contracts (DME MACs) have created guidance to assist Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers in understanding the information necessary to justify payment. Many errors reported in Medicare audits are due to claims submitted with incomplete or missing requisite documentation. #Aspx file viewer for mac license#To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. #Aspx file viewer for mac manual#Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. Product or publication creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions and/or making any commercial use of UB-04 Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any If an entity wishes to utilize any AHA materials, please contact the AHA at 31. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA.ĪHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution orĭerivative work without the written consent of the AHA. All rights reserved.Ĭopyright © 2013 - 2021, the American Hospital Association, Chicago, Illinois. The AMA assumes no liability for data contained or not contained herein.Ĭurrent Dental Terminology © 2021 American Dental Association. The AMA does not directly or indirectly practice medicine or dispense medical services. Applicable FARS/HHSARS apply.įee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not AMA CPT / ADA CDT / AHA NUBC Copyright StatementĬPT codes, descriptions and other data only are copyright 2021 American Medical Association.
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