Follow these guidelines for providing durable medical equipment in ambulatory surgical facility

We’d like to clarify the guidelines for durable medical equipment, prosthetic, orthotic and medical supplies provided on consignment in an ambulatory surgical facility location. The criteria and billing guidelines for DME and medical supplies haven’t changed.

DME/P&O providers should submit claims using the place of service code for an office (11) or home (12). If the DME/P&O item provided in an ambulatory surgical facility isn’t for home use, the DME/P&O supplier shouldn’t submit a claim. This item is considered inclusive of the ambulatory surgical facility charges.

Items required aftersurgery in ambulatory surgical facility

If a patient had surgery in an ambulatory surgical facility and afterward requires DME/P&O items for home use, then a prescription/certificate of medical necessity is required by the ordering physician. The patient can take the certificate of medical necessity to the DME provider of his or her choice to obtain the necessary items or supplies.

Items from an ambulatory surgical facility’s “consignment closet”

After a surgical procedure, the member also may obtain equipment or supplies from the ambulatory surgical facility’s consignment closet. However, before dispensing the item, the facility must verify the patient’s DME and medical supply benefit. For a consignment item, the participating DME provider must submit the professional claim for the item the patient is taking for home use. The prescription/certificate of medical necessity is required and must be kept on file. DME providers don’t bill for services used in an ambulatory surgical facility.

Note: For consignment items, the ambulatory surgical facility is responsible for:

• Ensuring the DME/P&O supplier is a participating Blue Cross Blue Shield of Michigan provider
• Verifying that the patient’s benefits cover these items before providing them

If these procedures aren’t adhered to, the ambulatory surgical facility may be held liable for the incurred cost.

How DME providers should submit claims

DME providers should submit claims using a professional claim form and only report the place of service codes of home or office. The office place of service codes should only be billed when the item is purchased in a retail store. A prescription/certificate of medical necessity must be kept on file. A DME provider should never submit a claim for equipment or supplies used in an ambulatory surgical facility location. Ambulatory surgical facility providers shouldn’t submit a separate claim for DME/P&O items. Items provided in an ambulatory surgical facility location for home use must be billed by participating DME providers.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.