Repairs

The definition of a repair is found in the CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110.2.A. That section generally defines repair as to fix or mend and to put the item back in good condition after damage or wear.

Repairs to items which a beneficiary owns are covered when necessary to make the items serviceable. However, "routine periodic maintenance", such as testing, cleaning, regulating, and checking is not covered.

Medicare does not separately reimburse for repairs of:

  • Items in frequent and substantial servicing payment category
  • Oxygen equipment
  • Items in capped rental payment category during capped rental period
  • Items covered under a manufacturer's or supplier's warranty
  • Previously denied items

A new CMN and/or treating physician/practitioner's order is not needed for repairs.

In the case of repairs to a beneficiary-owned DMEPOS item, if Medicare paid for the base item initially, medical necessity for the base item has been established. With respect to Medicare reimbursement for the repair, there are two documentation requirements:

  • Treating physician/practitioner must document that the DMEPOS item being repaired continues to be reasonable and necessary
  • Treating physician or supplier must document that the repair itself is reasonable and necessary

The supplier must maintain detailed records describing the need for and nature of all repairs including a detailed explanation of the justification for any component or part replaced as well as the labor time to restore the item to its functionality.

Repair HCPCS Codes

  • K0739 Repair or nonroutine service for DME other than oxygen requiring the skill of a technician, labor component, per 15 minutes
  • K0740 Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes

For DMEPOS repair claims, there must be information in the beneficiary's medical record to support that the DMEPOS item continues to be used by the beneficiary and remains reasonable and necessary as well as the necessity of the repair. Records must include the nature of the required repair and work performed to restore functionality of the DMEPOS item to meet the beneficiary's medical need. Parts and labor covered under manufacturer or supplier warranty are not considered reasonable and necessary.

For this purpose, documentation is considered timely when it is on record in the preceding 12 months, unless otherwise specified in relevant Medicare policy.

Documenting Repair Claims

For DMEPOS repair claims, there must be information in the beneficiary's medical record to support that the DMEPOS item continues to be used by the beneficiary and remains reasonable and necessary as well as the necessity of the repair. Records must include the nature of the required repair and work performed to restore functionality of the DMEPOS item to meet the beneficiary's medical need. Parts and labor covered under manufacturer or supplier warranty are not considered reasonable and necessary.

In the case of repairs to a beneficiary-owned DMEPOS item, if Medicare paid for the base equipment initially, medical necessity for the base equipment has been established.  With respect to Medicare reimbursement for the repair, there are two documentation requirements:

  1. The treating physician must document that that the DMEPOS item being repaired continues to be reasonable and necessary (see Continued Medical Need section above); and,
  2. Either the treating physician or the supplier must document that the repair itself is reasonable and necessary. 

For this purpose, documentation is considered timely when it is on record in the preceding 12 months, unless otherwise specified in relevant Medicare policy.

Loaner Equipment and Service Charge

Medicare will pay for a temporary replacement of a DMEPOS item while it is being repaired. In these situations, the DME supplier provides the beneficiary a "loaner" piece of equipment and bills Medicare HCPCS K0462 (Temporary Replacement for Patient Owned Equipment Being Repaired, Any Type).

Starting October 1, 2019, the DME MACs will begin denying loaner equipment HCPCS K0462 for missing information if it does not include the following in the narrative section of the claim.

  • Narrative description, manufacturer, and brand name/number of equipment being repaired
  • Narrative description, manufacturer, and brand name/number of replacement equipment
  • Description of what was repaired
  • Description of why repair took more than one day to complete

Narrative example for a temporary PAP device out for repair.

  • "Blower broken on PAP, Pur-06/15, loaner-ResMed S8 Elite II. PBO."

NOTE: There is no fee schedule for HCPCS K0462. Payment is determined as the equivalent of one month's rental for the type of equipment owned by the beneficiary.

You cannot charge the beneficiary any type of service charge, curb side fee, or delivery charge while you are repairing the equipment.

Repair Labor Billing and Payment Policy

Effective for dates of service on or after April 1, 2009, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) are instituting a billing and payment policy for common repairs based on standardized labor times. This applies to non-rented and out-of-warranty items. This effective date coincides with the effective date of the new code for repairs for non-oxygen equipment - K0739 (REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT OTHER THAN OXYGEN REQUIRING THE SKILL OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES). One unit of service = 15 minutes. 

The following table contains repair units of service allowances for commonly repaired items. Units of service include basic troubleshooting and problem diagnosis. Suppliers are reminded that there is no Medicare payment for travel time or equipment pick-up and/or delivery.

Type of Equipment Part Being Repaired/Replaced Allowed Units of Service (UOS)
CPAP Blower Assembly 2
Hospital Bed Pendant 2
Hospital Bed Headboard/footboard 2
Manual Wheelchair Anti-tipping device 1
Patient Lift Hydraulic Pump 2
Power or Manual Wheelchair Wheel/Tire (all types, per wheel) 1
Power or Manual Wheelchair Armrest or armpad 1
Power Wheelchair Drive wheel motors (single/pair) 2/3
Power Wheelchair Shroud/cowling 2
Power Wheelchair Joystick (includes programming) 2
Power Wheelchair Charger 2
Power Wheelchair Batteries (includes cleaning and testing) 2
Seat Lift Scissor mechanism 3
Seat Lift Hand Control 2

 

Suppliers may only bill the allowable units of service listed in the above table for each repair, regardless of the actual repair time. Claims for repairs must include narrative information itemizing each repair and the time taken for each repair. Suppliers are also reminded that Medicare does not pay for repairs to capped rental items during the rental period or items under warranty.

 

Last Updated Wed, 19 Aug 2020 20:40:08 +0000