Page 132 - Medicare Benefit Policy Manual

110.8 – DMEPOS Benefit Category Determinations
(Rev11769, Issued: 12-30-2022, Effective: 01-31-2023, Implementation: 01-31-23)

Whether or not an item or service falls under a Medicare benefit category,
such as the Medicare Part B benefit category for DME, is a necessary step
in determining whether an item may be covered under the Medicare
program and, if applicable, what statutory and regulatory payment rules
apply to the items and services. If the item is excluded from coverage by the
Act or does not fall within the scope of a defined benefit category, the item
cannot be covered under Medicare Part B.

Medicare Durable Medical Equipment, Prosthetic Devices, Prosthetics,
Orthotics and Supplies (DMEPOS) benefit category determinations
established on or after September 26, 2022, in accordance with the
procedures at 42 CFR §414.114 and §414.240, are listed below. These
procedures consider public consultation furnished at public meetings and in
writing in accordance with requirements for new DME items by section
531(b) of the Medicare, Medicaid and SCHIP Benefits Improvement and
Protection Act of 2000 (BIPA) (Pub L. 106-554). This section is a quick
reference tool for the benefit categories of items and services evaluated
using the procedures described above. The section is organized
alphabetically by the categories of items and services and then by the
benefit category status of each category of items and services.

Special note: the benefit category and payment rules for items and services
that are assigned to an existing HCPCS code(s) are determined by the
benefit category and payment rules for that HCPCS code(s). More
information on the final determinations for items and services reviewed
using the process described above is available at
https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublic
Meetings.