🏠 Understanding DME Coverage by Place of Service (POS)

Published in: Billing and Reimbursement
Date: July 15, 2025
By: Dan Fedor, Director of Reimbursement and Education, U.S. Rehab

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💡 Overview

Medicare Part B covers durable medical equipment (DME) when:

1. The beneficiary meets coverage criteria per policy, and
2. The beneficiary resides in what Medicare defines as home.

Meeting medical necessity is often straightforward — either through prior authorization or documentation review — but identifying the correct place of service (POS) can be tricky. Knowing when a DME item is covered depends entirely on whether the POS qualifies as the patient’s home.

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🏡 POS Codes Considered “Home” for DME Coverage

If the beneficiary resides in any of the following locations, DME is covered under Medicare Part B when criteria are met:

POS	Description
04	Homeless shelter
13	Assisted living facility
14	Group home
33	Custodial care facility
54	Intermediate care facility

These are all considered the beneficiary’s home for DME purposes.

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🏥 Skilled Nursing Facility (SNF) & Nursing Facility (POS 31/32)

This is where things get complicated.

POS 31 (Skilled Nursing Facility) and POS 32 (Nursing Facility) are not considered home — they are institutional settings. Therefore, Medicare Part B cannot pay for DME in these locations.

⛔ When the Beneficiary Is Under a Part A Stay (First 100 Days)

• The SNF is responsible for providing all medically necessary items.
• Payment is included under consolidated billing for the Part A stay.
• Suppliers must bill the SNF directly, not Medicare Part B.
• Use POS 31 → will result in a CO (Contractual Obligation) denial.
  • Beneficiary cannot be billed.
  • Secondary insurance cannot be billed.

💵 When the Beneficiary Is Not Under Part A

(After 100 days or private/self-pay)

• Part B still cannot pay, as POS 32 is not considered home.
• The beneficiary or secondary insurance may be billed.
• Use POS 32 → results in PR (Patient Responsibility) denial.
  • The beneficiary can be billed.

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❓ Common Q&A

Q: If the item is a custom or complex wheelchair, will Medicare B pay if the beneficiary is in POS 31/32?
A: No. DME is only covered when the beneficiary resides in what Medicare considers home. POS 31/32 are institutional.

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Q: If the beneficiary is self-paying for the SNF stay, will Medicare B pay for a complex manual wheelchair (E1161)?
A: No. Who pays for the room and board doesn’t matter — DME isn’t covered in POS 31/32.

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Q: What about long-term care (LTC)? Will Medicare B pay for a complex power wheelchair (K0861)?
A: Maybe. There’s no specific POS for LTC — it depends on how the facility is licensed.

• If the resident is in an assisted living section (POS 14) → DME is covered.
• If in a SNF section (POS 31/32) → DME is not covered.

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Q: Another supplier says they’re getting paid for E1161s in SNFs during private-pay stays — how?
A: Likely by using an incorrect POS (e.g., 12, 14, 33) that’s considered “home.”

• Medicare’s system won’t catch this since there’s no active Part A stay in the file.
• If done knowingly, this may constitute fraud (false claim).
• Medicare can recoup payment and refer to OIG for investigation.
  ➡️ Suppliers must verify POS before billing.

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Q: If a prior authorization or ADMC affirmation is obtained, can I go ahead and deliver the DME in a SNF?
A: No. Prior authorization only verifies medical necessity, not POS eligibility.

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Q: Can I deliver a wheelchair to a SNF before discharge to train the beneficiary?
A: Yes — Medicare allows a 48-hour training grace period.

• Deliver up to 48 hours prior to discharge.
• Beneficiary signs on delivery date, but date of service = discharge date.
• Document in the file why it was delivered early (training prior to discharge).

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Q: Will Medicare B pay for DME if the beneficiary is on hospice?
A: Yes, only if the DME is unrelated to the hospice diagnosis.

• Use GW modifier on the claim.
• Apply the correct POS.
• If the POS isn’t considered home, coverage rules above still apply.

Info

🔗 Use the Medicare Consolidated Billing Tool to verify DME coverage and hospice relationships.

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🧾 Quick POS Reference

Setting	POS	DME Coverage
Beneficiary home	12	✅ Covered
Homeless shelter	04	✅ Covered
Assisted living	13	✅ Covered
Group home	14	✅ Covered
Custodial care	33	✅ Covered
Intermediate care	54	✅ Covered
Skilled nursing facility	31	❌ Not covered – SNF responsible
Nursing facility	32	❌ Not covered – patient/secondary may be billed

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🧠 Visual References

Title	Image
DME Covered POS 2025
DME Hospice
E1161 in an SNF – NO
K0861 in an SNF – NO
Medicare B DME and Hospice
OIG SNF DME

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Tip

📞 Questions or training requests?
Contact Dan Fedor – dan.fedor@vgm.com · 570-499-8459

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Internal Education Resource – 2025
(Formatting optimized for billing staff and compliance training)