Eli's Rehab Report

Question: I know that any codes beginning with E or L must be billed by a durable medical equipment (DME) provider. Does this mean that all other HCPCS codes can be billed by a physicians office?

Oregon Subscriber

Answer: For the most part, yes. The guidelines at the beginning of each section (e.g., A, B, C, etc.) state which codes are billable to the DMERC (durable medical equipment regional carrier). Specifically, it states, Medicare claims for E codes fall under the jurisdiction of the DME regional carrier, unless otherwise noted. Similarly, claims in section A (transportation services) fall under the jurisdiction of the local carrier.

The HCPCS guide also contains special notations for codes subject to carrier discretion and those not covered by Medicare. Some codes in sections E and L may be billable by physicians offices, but such rules vary between the four regional DMERC carriers. Contact your DMERC carrier or review its policies before billing any HCPCS codes with which you are not familiar.


The reader questions were answered by Laureen Jandroep, OTR, CPC, CCS-P, owner of A+ Medical Management and Education, a coding and reimbursement consulting firm and a national CPC training curriculum site in Egg Harbor City, N.J.; Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.; Heidi Stout, CPC, coding and reimbursement manager at the University Orthopaedic Associates in New Brunswick, N.J.; Tiffany Z. Eggers, JD, MPA, policy director and legislative counsel for the American Association of Electrodiagnostic Medicine (AAEM) in Rochester, Minn.; and Terry Fletcher, CPC, CCS-P, an independent healthcare coding consultant in Dana Point, Calif.