Clarification: Requirements for providers billing DME prosthetics, orthotics and supplies

All durable medical equipment and medical supply providers that bill for custom prosthetic and orthotic services (including professional providers that meet Centers for Medicare & Medicaid Services exemption requirements) will be required to bill Blue Cross Blue Shield of Michigan claims with a separate, valid prosthetic and orthotic supplier provider PIN.

Although CMS allows for payment using only one provider DMEPOS NPI, effective July 1, 2018, Blue Cross will require a separate P&O provider NPI for billing custom P&O and a DME provider NPI for billing DME and off-the-shelf P&O services. All claims must include your NPI and the taxonomy code affiliated with your DMEPOS supplier number.

If you have a 10-digit DMEPOS supplier number, also known as a DMEPOS provider transaction access number, from the National Supplier Clearinghouse, and you bill for custom P&O HCPCS codes, submit a copy to Blue Cross’ Provider Enrollment and Data Management to request registration as a P&O provider. If you aren’t a registered P&O provider, your claims for custom P&O services will be rejected as not payable to your provider specialty and you’ll be liable for any costs.

Contact Provider Enrollment and Data Management at 1-800-822-2761 for more information to update your provider enrollment status.