Wiki POS for Orthotics billing

[steph2355]

Hi,

I need some help!

I have a Podiatrist that is billing out for orthotics, and I need to know what Place of Service to use? She is telling me to use home, but the orthotics are given to the patient in the office. Any help would be great!

I also have question on how to come up with a charge for the orthotics, this is kinda a gray area for us.

Thanks!

 

[RebeccaWoodward*]

The DME was dispensed in the office but you report the POS where the beneficiary will primarily use the DME.

Q11 My claim denied CO-58 (Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service). The beneficiary received the equipment in our office. Did this deny in error?

A11 No. Place of service (POS) 11 – Office is not a valid POS for DMEPOS items. For claims submitted to the DME MAC, the place of service is considered to be the place where the beneficiary will primarily use the DMEPOS item. The following is a list of valid POS codes for submission to the DME MAC:
01 Pharmacy
04 Homeless Shelter
09 Prison/Correctional Facility
12 Home
13 Assisted Living Facility
14 Group Home
16 Temporary Lodging
33 Custodial Care Facility
54 Intermediate Care Facility/Mentally Retarded
55 Psychiatric Residential Treatment Center
65 End Stage Renal Disease Treatment Facility (valid POS for Parenteral Nutrition Therapy)

Coverage consideration for DMEPOS items in a Skilled Nursing Facility (31), unless the beneficiary is in a covered Part A stay, or a Nursing Facility (32) is also considered for certain types of equipment. Please refer to the DME MAC Jurisdiction C Supplier Manual, Chapter 6, for a complete list of these items, as well as additional information regarding place of service

http://www.cignagovernmentservices.com/jc/help/faqs/current/general.html

Chpt 6:

http://www.cignagovernmentservices.com/jc/pubs/supman/index.html

 

[hopepg]

We bill POS 12 for home