Tips to Better Understand DME Billing Guidelines

Durable Medical Equipment (DME) payor medical policies and DME billing guidelines will change over time (some product lines change more often than others). Building and maintaining a process for all referrals will help you stay current on all changes, and will save you time and effort. The Centers for Medicare and Medicaid Services (CMS) website is a helpful way to stay up to date on all Medicare and Medicaid DME guidelines.

3 Helpful Tips to Follow for Billing Guidelines 

DME billing requires accurate, top-level coding to ensure correct claims submission, especially when changes or updates occur. Here are three tips to help create an efficient billing process so that you will be ready when guidelines change. 

#1 Provide Correct Documentation 

Accurate claims submission needs correct coding and proper documentation. This includes confirming with insurance companies if specific documents are required before dispensing an order. These extra steps will save you time and effort to prevent denied claims if an insurance company has changed its policies. 

HCPCS Level II Code Ending in 99

When an HCPCS code ends in” 99,” you will need to provide the required support documents when you submit the claim. If the documents aren’t with the paperwork, the insurance company will suspend the claim until the documents are received and reviewed (results in delayed claim payments). 

#2 Establish Medical Necessity 

For a patient to receive a DME item, their medical record must show it’s a medical necessity to assist in the treatment of their diagnosed medical condition. Local Coverage Determinations (LCDs) are policies that can address the need for DME items. Understanding the specific LCDs for your area will ensure correct claims reimbursements.

#3 Streamline Your Billing Services 

Putting a billing system in place will help you streamline the claims processes. So when there’s a guideline change, an efficient billing process will allow you to make the needed adjustment and continue submitting claims. 

Identify steps in the process that can be tracked and monitored. By identifying these areas, trends and issues can be uncovered quickly, and growth potential can be realized.

5 Tips to Stay Current DME Market Trends

Here are five ways to stay current on DME billing updates and changes. 

1. Industry Publications 

Subscribe to online/print trade journals and magazines and take a few minutes each week to read one article about DME news. 

2. Share Industry Articles 

Share any interesting articles or news about the DME industry. Even consider creating an online source where employees can share these articles. 

3. Set Up Email Notifications 

Create RSS feeds that are emailed to you so you can follow essential topics related to DME. 

4. Follow CMS for Updates

Visit the DME Equipment Center on for updates on current and new policy changes. 

5. Follow Medbill’s News Section 

Subscribe to Medbill’s blog on the “News” section of our website, We stay current on the latest DME industry news.

Additional Resources for DME Billing Guidelines 

If you would like to read additional information on DME billing guidelines, view the articles below. 

Medbill Can Keep You Updated on DME Billing Guidelines 

Medbill is a trusted DME Billing Company. The Medbill team helps their customers stay current and better understand DME billing requirements. 

Find out how Medbill can help you stay current on the ever-changing DME industry by contacting us