Durable Medical Equipment (DME) billing under Medicare is one of the most detail-driven parts of medical billing. Every code, modifier, and document can mean the difference between fast payment and frustrating denials.
At A2Z Billings, we’ve seen how minor billing errors can cost providers thousands—and how the proper process can keep reimbursements consistent, compliant, and on time.
This guide breaks down exactly how to submit DME claims correctly, what Medicare requires, and how to keep your cash flow predictable.
DME Billing for Medicare?
Durable Medical Equipment includes items like wheelchairs, walkers, oxygen equipment, and hospital beds and essential tools for patient care. Medicare Part B typically covers DME if:
- The patient’s doctor prescribes it for home use.
- The equipment is durable, reusable, and medically necessary.
- The supplier is enrolled and approved by Medicare.
Getting reimbursed is not an easy process. It requires precise coding, documentation, and compliance at every step.
How to Submit DME Claims to Medicare
Confirm Patient and Provider Eligibility
Start by confirming that both the patient and the supplier are eligible for Medicare billing. Enrollment in Medicare Part B is required to be in eligibility criteria. An active Medicare Supplier Number (PTAN) is required for the DME supplier Incompletion of this step is one of the main reasons claims get rejected.
Complete Documentation
Before billing, make sure all necessary paperwork is ready and signed. This typically includes:
Physician’s Prescription:
A detailed description of the equipment.
Medical Necessity Proof:
Clinical notes, test results, or other supporting documentation.
Delivery Receipt:
A signed receipt confirming the patient received the equipment.
Incomplete or missing paperwork is the main reason Medicare holds or denies DME claims.
Use Correct HCPCS Codes
Every piece of equipment has a specific Healthcare Common Procedure Coding System code. Use of wrong codes can lead to various issues like delay in payment for weeks.
Add the Right Modifiers
Modifiers explain the “how” and “why” of each claim to Medicare. For example:
- RR – Rental
- NU – New equipment purchase
- MS – Maintenance and servicing
Adding the correct modifiers ensures Medicare pays at the right rate.
Choose the Correct Place of Service Code
Medicare only reimburses DME used in a patient’s home, not in facilities. Always use POS code 12 (Home) unless stated otherwise.
File Electronically Through the DME MAC Portal
Every region has a MAC processing claims, and sending electronically will prevent errors and speed up reimbursemen
Optimize Your Reimbursement
Stay updated:
Have complete Medicare Local Coverage Determination (LCD) information and National Coverage Determination (NCDs); it will help prevent costly discard from the payer.
Remain Audit-Ready:
Make sure that all patient records, prescriptions, and claim files are easily accessible. Having thorough records is your best defense because Medicare can audit claims from as far back as seven years ago.
Keep Your Team Sharp:
It’s critical to provide staff with regular training. Medicare’s regulations are subject to frequent changes, and an experienced staff can spot possible billing issues before they result in late payments.
The Benefits of Professional DME Billing
A single incorrect code can lead to unlimited issues including delay in payments. Having professionals on your side can therefore make all the difference. Our professionals know the system inside and out, ensuring your claims are accurate, compliant, and paid on time
Our DME billing professionals at A2Z Billings take care of everything. We handle the billing so you can concentrate on patient care while we verify paperwork and monitor final reimbursements.
DME billing under Medicare is not just about filling out forms. It involves accuracy, compliance, and strategy. When managed properly, it can lead to steady cash flow and fewer denials.
At A2Z Billings, we bring proven experience and deep Medicare knowledge to help healthcare providers get paid faster and more reliably. If you’re ready to simplify DME billing and maximize your reimbursements, reach out today—let’s make your billing process as durable as your equipment.
FAQs About DME Billing for Medicare
What is DME?
ME stands for Durable Medical Equipment, which includes things like oxygen tanks, wheelchairs, and other necessary equipment
What’s buying and renting a DME?
If you’re buying, the supplier uses the NU modifier. If you’re renting, they use RR. Rentals are usually billed monthly until you own the equipment.
Why do DME claims get denied?
Some common reasons include:
Missing prescriptions
Wrong codes
Expired paperwork
Mismatched patient info
Can I upgrade my DME equipment and still get covered?
You can upgrade, but Medicare will only pay for the standard item. You’ll need to cover the difference
What documentation is necessary for DME reimbursement?
You will typically need a physician’s order, proof of delivery, and medical records that indicate the need for the DME. Some devices also will require a face-to-face assessment or prior authorization.
Does Medicare pay for every kind of durable medical equipment?
No, it only pays for durable medical equipment that conforms to Medicare’s definition—primarily devices that are durable, medically necessary, and used in the home. All luxury or convenience items offered by suppliers, such as air purifiers or exercise devices are not covered.
Can a patient rent durable medical equipment instead of purchasing it?
Yes, in a lot of cases. C; if the patient won’t own the equipment and will not incur a claim in Medicare guidelines or practices, Medicare will allow for the patient to rent equipment, like an oxygen concentrator or hospital bed if it makes sense to do so.
What is the best way to track and appeal denied claims for durable medical equipment?
You should keep a detailed log for every claim submitted, including; the date submitted, claim number, amended payment status on appeal for payments, or request for a review on the denial to get reimbursed for the durable medical equipment. If required, submit a formal appeal if warranted.
Thomas
Can a Out of Network DME Provider enroll in DMEPOS and obtain PTAN. If Yes, could you suggest us the best way to get enrolled and get paid for the DME Services. We are enrolled with Commercial Humana/Aetna but not enrolled Humana PPO/Aetna PPO ( Medicare Advantage)
Admin
Yes. An out-of-network DME provider can enroll in Medicare DMEPOS and obtain a PTAN (Provider Transaction Access Number).
Key Points:
1- To bill Traditional Medicare, you must enroll in Medicare DMEPOS and receive a PTAN through the National Supplier Clearinghouse (NSC).
2- Being enrolled with commercial Humana/Aetna does not automatically allow billing their Medicare Advantage (PPO) plans.
3- For Humana PPO / Aetna PPO Medicare Advantage, you must enroll directly with each MA plan separately (even if you are already in-network for commercial plans).
Best Way to Get Enrolled & Paid
1- Enroll in Medicare DMEPOS
Submit CMS-855S application.
Ensure active NPI, surety bond, accreditation, and meet DMEPOS supplier standards.
After approval, obtain your PTAN.
2- Complete PECOS Enrollment
Enroll/revalidate through the Medicare PECOS system.
Link your NPI and PTAN correctly.
3- Contract with Medicare Advantage Plans
Contact Humana Medicare Advantage and Aetna Medicare Advantage provider contracting departments.
Apply specifically for DME participation under their MA networks.
Confirm fee schedules and prior authorization requirements.
4-Verify Authorization & Billing Rules
Always check eligibility and prior auth.
Follow LCDs and documentation requirements to avoid denials.
Thomas
Can we call Humana PPO / Aetna PPO Medicare Advantage and enroll directly with each MA plan separately without enrolling in DMEPOS?
Thomas
Can we Call only Humana PPO / Aetna PPO Medicare Advantage (MA PLAN) only, and get enrolled directly with each MA plan separately without enrolling in DMEPOS?
Admin
No, you generally cannot enroll directly with only Humana PPO or Aetna PPO Medicare Advantage (MA) plans for DME services without being properly credentialed.
For Medicare Advantage plans:
If you are providing DME (Durable Medical Equipment) to MA patients, you must first be enrolled as a Medicare DMEPOS supplier with traditional Medicare.
Most MA plans require providers/suppliers to have active Medicare enrollment and a valid DMEPOS supplier number.
MA plans typically verify your Medicare status before contracting.
Exception:
If you are not billing for DME (for example, professional services only), DMEPOS enrollment may not be required. However, this depends on the service type and the plan’s contracting requirements.
Key Requirement for MA Plan DME Contracting:
To furnish DME to Medicare Advantage members, you must obtain DMEPOS enrollment before contracting with Humana or Aetna MA plans.