How do you code injections or durable medical equipment (DME) for Medicare?

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To code injections and Durable Medical Equipment (DME) for Medicare, follow these steps within the 1500-character limit:

For injections, use HCPCS Level II codes for the drug and CPT codes for the administration. The drug code (e.g., J-code like J1885 for ketorolac) should include the dosage and units. Use the correct administration code (e.g., 96372 for subcutaneous or intramuscular injection). Ensure the drug is Medicare-covered and medically necessary with documentation to support diagnosis (linked via ICD-10 code). Always verify NDC (National Drug Code) if required.

For DME, use HCPCS Level II codes (e.g., E0601 for CPAP). Submit claims with:

• The place of service (typically 12 for home),

• Modality (purchase vs rental)—indicated via modifiers such as RR (rental), NU (new), or UE (used),

• KX modifier if medical necessity is documented.

DME requires a detailed written order, possibly a Certificate of Medical Necessity (CMN), and often prior authorization for certain items.

Always refer to Medicare LCDs and NCDs for coverage specifics and documentation requirements. Claims are submitted on the CMS-1500 form (or electronically via 837P), and compliance with Medicare billing guidelines is essential to avoid denials.

Let me know if you need help with a specific code or item.

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