NAIMES: Mail-order diabetic supplies clarification

HALIFAX, Va., Sept. 26, 2012—The National Association of Independent Medical Equipment Suppliers (NAIMES) reports that when any Medicare-enrolled supplier delivers diabetic testing supplies to a beneficiary’s residence by mail order, the KL modifier (DMEPOS item delivered via mail) must be submitted on the claim line for each diabetic supply item delivered. However, when diabetic testing supplies are obtained from a local supplier storefront, the KL modifier should not be used. These rules surrounding use of the KL modifier apply to all Medicare-enrolled suppliers regardless of whether the beneficiary’s residence or the supplier’s location is in a competitive bidding area (CBA). 

Medicare beneficiaries who permanently reside in a mail-order CBA may purchase their diabetic supplies from a mail-order contract supplier for the area in which the beneficiary resides, or a non-contract supplier in cases where the supplies are not furnished on a mail-order basis. A map and list of ZIP codes in each of the mail-order CBAs is available on the Competitive Bidding Implementation Contractor (CBIC) website, www.dmecompetitivebid.com.

According to the site, the current definition of “mail-order” refers to items ordered remotely (i.e., by phone, e-mail, Internet, or mail) and delivered to a beneficiary’s residence by common carriers (e.g., U.S. Postal Service, Federal Express, United Parcel Service, or other shipping or courier service companies) and does not include items obtained by beneficiaries from local supplier store fronts. “Common carrier,” in its basic meaning, includes individuals or companies that transport goods or cargo (e.g., diabetic testing supplies) for compensation. This means that suppliers that pay a common carrier to transport diabetic testing supplies to Medicare beneficiaries’ homes are furnishing mail-order diabetic supplies even if the suppliers have contract arrangements with the common carrier to deliver these items.

As a reminder, a national competition is currently in progress for suppliers who would like to furnish diabetic testing supplies that are delivered to beneficiaries’ residences. Under the National Mail-Order Competition for Diabetic Supplies, the definition of the term “mail-order” will change to include items shipped or delivered to the beneficiary’s residence by any method. For more information about the National Mail-Order Competition for Diabetic Supplies, visit the CBIC website at www.dmecompetitivebid.com. Also visit www.dmehelp.org.