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Linda Collins Blogger

Can a Physician Bill for Crutches if Located in a Competitive Bidding Area?

Posted by Linda Collins | January 26, 2016

According to the Competitive Bidding Program, Medicare beneficiaries may receive crutches, a cane, walkers or a folding wheelchair from a physician and the physician may be paid for the item under specific conditions.

Physicians, including podiatric physicians; nurse practitioners; physician assistants; and clinical nurse specialists who are enrolled as a DMEPOS supplier my furnish crutches, canes, walkers or folding manual wheelchair to a patient as part of his or her professional services. The following guidelines must be followed:

  • The claim must be submitted to the appropriate DME Medicare Administrative Contractor (DME MAC.)
  • The DMEPOS billing number must be on the claim.
  • Use the "KV" modifier along with the appropriate HCPCS codes.
  • The date of service must have the same date of service as the professional service.
  • The professional service/office visit claim is billed to the Part A/Part B MAC.
  • Medicare pays the established single payment amount.

More information about the DMEPOS Competitive Bidding Program may be found here

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