Category: DME Coding

CMS has reinstated codes L3660 “SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT”; L3670 “SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT”; and L3675 “SHOULDER ORTHOSIS, VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE OR EQUAL, PREFABRICATED INCLUDES FITTING AND ADJUSTMENT” with the original language.  In making this change, the CY 2011 HCPCS Annual Tape will no longer reflect a termination date of 12/31/10 for these codes.  This change has been posted to the 2011 HCPCS Corrections document located on the HCPCS web page at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp

DMEPOS suppliers can use Internet-based PECOS to enroll, make a change in their enrollment record, view their Medicare enrollment information on file with Medicare, and check on the status of a Medicare enrollment application via the Internet. 

Using Internet-based PECOS:  Before you begin to use Internet-based PECOS, you:

• Should review the document titled, “Internet-based PECOS — Getting Started Guide for Suppliers of DMEPOS” to obtain access to Internet-based PECOS. This document can be found at: http://www.cms.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp
• Must obtain and designate a unique National Provider Identifier for each business/practice location that you are enrolling or have enrolled with the National Supplier Clearinghouse (NSC). Note: there is an exception for sole proprietorships.
• Enter the “legal business name” for the supplier of DMEPOS as it shown on the IRS documentation and on the National Plan and Provider Enumeration System (NPPES).  Both PECOS and NPPES require the submission of the “legal business name”.

Finalizing Submission and Responding to Development Request: After submitting an enrollment application via Internet-based PECOS, you:

• Must print, sign and date (blue ink recommend) the Certification Statement(s) and mail the Certification Statement(s) and supporting documentation to the NSC within 7 days.  The NSC will not begin to process your enrollment application until it receives a signed and dated Certification Statement.  
• May be asked to make corrections or submit additional documents by the NSC.  In order for your application to be processed, you must submit this information promptly.

Pending Paper Enrollment Application: If a DMEPOS supplier has a pending paper enrollment application, the supplier should not submit an Internet-based PECOS enrollment application for the same enrollment or change of information. 

More Information:  For more information about Internet-based PECOS, including contact information for the External User Services (EUS) Help Desk, go to www.cms.hhs.gov/MedicareProviderSupEnroll and select the “Internet-based PECOS” tab on the left side of screen.  The EUS Help Desk provides assistance to providers and suppliers if they encounter an application navigation or systems problem with Internet-based PECOS.

New Rule Strengthens Supplier Enrollment Standards to Help Prevent Fraud

The Centers for Medicare & Medicaid Services (CMS)  issued a final rule representing another step to increase protections for Medicare and beneficiaries from potentially fraudulent suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). 

The new regulation enhances Medicare enrollment standards for DMEPOS suppliers by adding several new standards and strengthening existing standards that suppliers must meet before being able to furnish equipment and supplies to Medicare beneficiaries. These new and stronger standards will help to reduce fraud in Medicare and provide beneficiaries with additional assurance that they are being served by legitimate suppliers who meet Medicare’s standards.

Please click here for the entire press release DMEPOS  

Please click here for the Federal Register   Federal Register – 8-27-10 – 2010-21354