Delivery of Orthoses or Other DMEPOS Items and Hospitalization

Original Effective Date: 03/15/2002
Revision Effective Date: 11/01/2013

This serves to remind suppliers that if a patient requires a DMEPOS item during hospitalization, the supplier may provide it for use during the patient's hospital stay under the following conditions:

1. If a DMEPOS item such as an orthosis is to be used initially in the hospital, the item should not be delivered to the patient before hospital admission. Items delivered to the home setting before the patient has need of them are denied by the DMERC as not medically necessary. However, this requirement does not prohibit the supplier or fitter from evaluating, fabricating, and/or fitting an orthosis before hospitalization or surgery.

2. If an item is dispensed to the patient and initially used in the hospital, for example following elective surgery, reimbursement for the item is included in Medicare's payment to the hospital. The supplier must not bill the DMERC but must seek reimbursement from the hospital. Under these circumstances claims billed to the DMERC will be denied as incorrect jurisdiction.

On the other hand if an item is intended for initial use after hospitalization and the item is delivered to a hospitalized patient for the sole purpose of fitting or training up to two days before discharge to the home setting, the item should be billed to the DMERC with the discharge date as the date of service.

(See the article, "Delivery of DMEPOS Items Prior to Hospital Admission" in the Spring 1999 DMERC Dialogue.)

            Last Updated Wed, 10 May 2017 09:44:00 +0000