Are You Providing Accessories or Supplies for Beneficiary Owned Equipment?

Suppliers must ensure that the beneficiary information is on file with Medicare Fee for Service (FFS) to avoid denials. Suppliers are reminded that additional documentation is required in situations where supplies and accessories are provided for a piece of equipment not paid for by Fee-For- Service (FFS) Medicare. In addition, drugs used with a nebulizer or external infusion pump would be considered supplies to a covered piece of DME.

Claims for supplies and accessories used with beneficiary owned equipment must include all three pieces of information listed below. Claims lacking any one of the above elements will be denied for missing information with reason code 16, remark code M124. Refer to the Denial Code Resolution page on resolving and avoiding this denial in the future.

Elements required

  • HCPCS code of base equipment; and,
  • A notation equipment is beneficiary-owned; and,
  • Date beneficiary obtained equipment (approximate)
    • i.e. Beneficiary owned E0601 purchased June 2015

Some common reasons for denials for beneficiary owned equipment not on file.

  • Beneficiary purchased equipment prior to becoming Medicare eligible
  • Beneficiary purchased equipment with another supplier
  • Beneficiary purchased Glucose Monitor (E0607) and then purchased a Continuous Glucose Monitor (K0554) (The supplies for E0607 are not the same codes used with the K0554)
  • Narrative does not match base equipment
  • Base item coverage criteria not met

Once the item purchased is on file, subsequent supply claims do not require a narrative.

 

            Last Updated Mon, 28 Jun 2021 16:43:59 +0000