Notification Number: 357
Effective date: 11/9/2015
Notification date: 8/7/2015
Category: HCPCS - DMEPOS
Topic: Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) bundled to the inpatient admission
According to the CMS Medicare Claims Processing Manual, DMEPOS items are for use by a patient in his or her home. The institution is expected to provide all medically necessary DMEPOS items during a patient’s inpatient stay.
Claim edits do not supersede the necessity to obtain preauthorization. Preauthorization requirements are still applicable. Modifiers should be used when appropriate to accurately represent the services rendered. The use of modifiers may impact Humana’s application of these edits. For additional information, consult professional coding resources.
*All edits previously posted on Humana.com/providers for fully insured commercial Humana members may be applied to self-funded members, when requested by the self-funded group.