Guidance on Implementing Edits for Certain DMEPOS Items

CR 7333 rescinds and replaces CR 7073.

Section 302 of the Medicare Modernization Act of 2003 (MMA) added a new paragraph 1834(a)(20) to the Social Security Act (the Act). This paragraph requires the Secretary of the Department of Health and Human Services to establish and implement quality standards for suppliers of DMEPOS. All suppliers that furnish such items or services set out at subparagraph 1834(a)(20)(D) as the Secretary determines appropriate must comply with the quality standards in order to receive Medicare Part B payments and to retain a Medicare supplier number to be able to bill Medicare. Pursuant to subparagraph 1834(a)(20)(D) of the Act, the covered items and services are defined in Section 1834(a)(13), Section 1834(h)(4) and Section 1842(s)(2) of the Act. The covered items include: 

  • DME
  • Medical supplies
  • Home dialysis supplies and equipment
  • Therapeutic shoes
  • Parenteral and enteral nutrient, equipment and supplies
  • Transfusion medicine
  • Prosthetic devices, prosthetics and orthotics

Section 154(b) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) added a new subparagraph (F) to Section 1834(a)(20) of the Act. In implementing quality standards under this paragraph the Secretary will require suppliers furnishing items and services directly, or as a subcontractor for another entity, to have submitted evidence of accreditation by an accreditation organization designated by the Secretary. This subparagraph states that eligible professionals and other persons (defined below) are exempt from meeting the accreditation deadline unless CMS determines that the quality standards are specifically designed to apply to such professionals and persons. The eligible professionals who are exempt from meeting the September 30, 2009, accreditation deadline (as defined in Section 1848(k)(3)(B)) include the following practitioners: 

  • Physicians (as defined in Section 1861(r) of the Act)
  • Physical therapists
  • Occupational therapists
  • Qualified speech-language pathologists
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Certified nurse-midwives
  • Clinical social workers
  • Clinical psychologists
  • Registered dietitians
  • Nutritional professionals

Additionally, MIPPA allows the Secretary to specify 'other persons' that are exempt from meeting the accreditation deadline unless CMS determines that the quality standards are specifically designed to apply to such other persons. At this time, 'such other persons' are specifically defined as the following practitioners:

  • Orthotists
  • Prosthetists
  • Opticians
  • Audiologists
  • Pharmacies - who have an NSC-MAC approved attestation for exemption from accreditation for a Medicare enrolled pharmacy

Note: See the NSC-MAC website at www.palmettogba.com/medicare or the CMS website in accordance with Section 3109(a) of the Patent Protection and Affordable Care Act.

All supplier types (except those listed above) who furnish items and services requiring accreditation, directly or as a subcontractor for another entity, must have submitted evidence of accreditation by an accreditation organization designated by the Secretary on or after October 1, 2009. Edits for the Healthcare Common Procedure Coding System (HCPCS) codes in the product categories designated by MIPPA as requiring accreditation will be in effect starting July 5, 2011.

Read the MLN Matters article (PDF, 105 KB) in its entirety.

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Telephone: 866-238-9652

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Address:

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Palmetto GBA, AG-495

P.O. Box 100142

Columbia, SC 29202-3142

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