Durable medical equipment billing for DMEPOS suppliers: written orders and the records behind them, proof of delivery, capped rentals and purchases, refills, coverage modifiers and prior authorization, billed to Medicare’s DME contractors, Medicaid and commercial plans.
A DME claim is paid on paper the supplier did not write. The written order, the treating practitioner’s records and the proof of delivery all have to be complete before the claim goes out, rentals are billed month by month with the right modifiers, refills follow the timing rules, and anything that comes back is worked until it is paid.
$2.3B
in improper Medicare payments for durable medical equipment, prosthetics, orthotics and supplies in CMS’s 2025 review, a 24.1% improper payment rate
83.3%
of those errors were missing or insufficient documentation, and 50.5% had no documentation at all
Equipment suppliers carry the risk for records they depend on others to produce. The order comes from the treating practitioner, the medical need lives in the practitioner’s notes, and the delivery has to be proven by the supplier. When Medicare reviews a claim, a missing element in any of those can mean the payment is taken back, often months after the equipment was delivered.
The records behind the item decide the claim. That is why we check the order, the supporting notes and the proof of delivery for every item before the claim goes out.
DME billing runs on documents and schedules. Each item needs the right paperwork once and the right billing every month after. Here is where claims in each area fail, and what we do.
Pays forEquipment and supplies backed by a complete written order and the practitioner’s records showing need.
Where it breaks
What we do
Pays forCapped rentals, inexpensive or routinely purchased items, and items bought outright.
Where it breaks
What we do
Pays forRecurring supplies such as CPAP, diabetic and urological supplies, shipped on a schedule.
Where it breaks
What we do
Every Medicare DME claim needs a standard written order with six elements: the patient’s name or Medicare number, the order date, a description of the item (a HCPCS code, its narrative or a brand and model), the quantity to be dispensed for supplies, the treating practitioner’s name or NPI, and the practitioner’s signature. For items on CMS’s required list, the order must be in hand before delivery, and the practitioner must have seen the patient within the six months before the order.
Proof of delivery is the supplier’s own record, kept for seven years. It shows the patient’s name, the delivery address, a description of each item and its quantity, the delivery date and the signature of the patient or their designee, or shipping records that track the package to the patient.
What we do: before a claim goes out, we check the order against all six elements, confirm the face-to-face visit and order timing for items that need them, and match the proof of delivery to the items and dates billed.
DME is billed with HCPCS Level II codes, most of them for equipment, supplies or orthoses. These are the categories we see most, with what payers check on each.
| Code | What it covers | What payers look for |
|---|---|---|
| E0601 | CPAP device | Capped rental; the face-to-face visit, sleep test and adherence documented. |
| A7030 to A7039 | CPAP masks, cushions, tubing and filters | Replacement schedules and refill timing. |
| E1390 | Oxygen concentrator | Qualifying test results and a 36-month rental period. |
| K0001 to K0007 | Manual wheelchairs | Mobility need in the home, documented in the practitioner's notes. |
| E0260 | Semi-electric hospital bed with mattress | The coverage criteria for a hospital bed, documented. |
| E2103A4239 | Non-adjunctive CGM receiver and monthly supply allowance | The CGM coverage criteria and a visit every six months. |
| A4253 | Blood glucose test strips, per 50 | Quantities within limits for the patient's treatment. |
| L0000 to L4631 | Orthoses | Prefabricated or custom, off-the-shelf or fitted, and the order. |
Each month of a rented item.
KH for the first month, KI for months 2 and 3, KJ for months 4 to 13 of a capped rental.
An item bought new rather than rented.
The coverage criteria in the policy are met and documented.
Medicare: an item that may not be covered, with a signed notice.
Medicare: an item expected to be denied, with no signed notice.
Sources: Medicare Claims Processing Manual, chapter 20 (DMEPOS); DME MAC local coverage determinations and policy articles; Medicare Program Integrity Manual, chapter 5. HCPCS descriptions are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, order completeness, proof of delivery, rental modifiers and refill timing, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list active rentals, recurring supply patients and your main referral sources, and agree how escalations work. Most practices are live within one to two weeks.
Equipment, supplies and rental months are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, orders, delivery records and rental months checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the software you already use and through your existing clearinghouse. The systems below are the medical practice systems we work in most; tell us what you use, and we will confirm how we would work in it.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Supplier revenue comes in monthly: rentals, refills and recurring supplies, each a modest claim. A fee that is a share of collections tracks that steady flow and rewards keeping every month paid.
Summit Billing Solutions charges between 3% and 9% of monthly collections. Your rate depends on the number of active rentals and supply patients, your product mix, how many items need prior authorization and the state of the receivables, which we see in the free account review.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, order completeness, proof of delivery, rental modifiers and refill timing, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Dr Ste 3, Salem, NH 03079-4827
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
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