What are the procedure codes used by the lab for reimbursement and why does the DMERC tell us that the codes are not reimbursable by the DMERC? (Will my patient get a bill?)?
The lab uses three codes depending on the procedure: a. 94760 b. 94761 c. 94762 The DMERC (Durable Medical Equipment Regional Carrier) does not cover these benefits as CMS has very specific prohibitions against a DME performing the qualifying study. Oximetry Company, LLC is an Independent Diagnostic Testing Facility (IDTF) approved by Medicare to perform such studies. The lab does not file claims with a DMERC, rather the lab claims go to a similar carrier as those coming from a physician or hospital. The rules of the DMERC apply to DMEs, not IDTFs, physicians, and hospitals.
The lab uses three codes depending on the procedure: a. 94760 b. 94761 c. 94762 The DMERC (Durable Medical Equipment Regional Carrier) does not cover these benefits as CMS has very specific prohibitions against a DME performing the qualifying study. Night Hawk Sleep Systems is an Independent Diagnostic Testing Facility (IDTF) approved by Medicare to perform such studies. The lab does not file claims with a DMERC, rather the lab claims go to a similar carrier as those coming from a physician or hospital. The rules of the DMERC apply to DMEs, not IDTFs, physicians, and hospitals.
