Page 131 - Medicare Benefit Policy Manual

For mail order DMEPOS items, the date of service on the claim must be the shipping
date.

The date of service on the claim must be the date that the DMEPOS item(s) was received
by the nursing facility if the supplier delivered it or the shipping date if the supplier
utilized a delivery/shipping service.

An exception to the preceding statements concerning the date of service on the claim
occurs when items are provided in anticipation of discharge from a hospital or nursing
facility. If a DMEPOS item is delivered to a patient in a hospital up to two days prior to
discharge to home and it is for the benefit of the patient for purposes of fitting or training
of the patient on its use, the supplier should bill the date of service on the claim as the
date of discharge to home and should use POS=12.

See the Medicare Program Integrity Manual, Chapter 5, “Items and Services Having
Special DME Review Considerations,” for additional information pertaining to the date
of service on the claim. Also see the Medicare Claims Processing Manual, Chapter 20,
“Durable Medical Equipment, Surgical dressings and Casts, Orthotics and Artificial
Limbs, and Prosthetic Devices,” for additional DME billing and claims processing
information.

110.6 - Determining Months for Which Periodic Payments May Be
Made for Equipment Used in an Institution
(Rev. 1, 10-01-03)
A3-3113.7.D, HO-235.7.C

If a patient uses equipment subject to the monthly payment rule in an institution, which
does not qualify as his or her home, the used months during which the beneficiary was
institutionalized are not covered.

110.7 - No Payment for Purchased Equipment Delivered Outside the
United States or Before Beneficiary’s Coverage Began
(Rev. 1, 10-01-03)
A3-3113.7.C

In the case of equipment subject to the lump sum payment rules, the beneficiary must
have been in the United States and must have had Medicare coverage at the time the item
was delivered. Therefore, where an item of durable medical equipment paid for as a
lump sum was delivered to an individual outside the United States or before his or her
coverage period began, the entire expense of the item would be excluded from coverage.
Payment cannot be made in such cases even though the individual later uses the item
inside the United States or after his or her coverage begins.

If the individual is outside the U.S. for more than 30 days and then returns to the U.S., the
DME MAC determines medical necessity as in an initial case before resuming payments.