Pharmacies
Pharmacies typically enroll with the National Supplier Clearinghouse via the Form CMS-855S. However, there are certain covered drugs that are billed through the physician fee schedule and not the schedule for durable medical equipment, prosthetics, orthotics and supplies. These drugs must be billed to the Part A/B Medicare Administrative Contractor (A/B MAC), meaning that the pharmacy must enroll with the A/B MAC via the Form CMS-855B.
For more information on the billing and coverage policies for Part B drugs, see:
• Pub. 100-04, Claims Processing Manual, chapter 17
• Pub. 100-02, Benefit Policy Manual, chapter 15, sections 50 through 50.6
15.4.2.5 - Portable X-Ray Suppliers (PXRSs)
(Rev. 561, Issued: 12-12-14, Effective: 03-18-15, Implementation: 03-18-15)
A. General Background Information
To qualify as a portable x-ray supplier (PXRS), an entity must meet the conditions for coverage discussed in 42 CFR § 486.100-110.
A PXRS can be simultaneously enrolled as a mobile IDTF, though they cannot bill for the same service. A PXRS requires a State survey, while a mobile IDTF does not (although an IDTF requires a site visit).
A PXRS does not have a supplier agreement.
B. Enrollment of PXRSs
1. Section 4 of the Application
In order to enroll as a PXRS, a supplier must complete a Form CMS-855B, undergo a State survey, and obtain RO approval. In Section 4 of the Form CMS-855B, the PXRS must furnish certain information, including:
• Whether it furnishes services from a “mobile facility” or “portable unit.” The former term typically describes a vehicle that travels from place to place to perform services inside the vehicle. Examples of such vehicles include mobile homes or trailers. A “portable unit” exists when a supplier transports medical equipment to a particular location. Unlike with mobile facilities, the equipment on a portable unit is separate from and unattached to the vehicle.
• A PXRS can be either a mobile facility or portable unit, although it usually is the latter. A mobile IDTF, on the other hand, while it too can be either, is typically a mobile facility.
• Its base of operations. This is where personnel are dispatched from and where equipment is stored. It may or may not be the same address as the practice location.
• All geographic locations at which services will be rendered.
• Vehicle information if the services will be performed inside or from the vehicle. Copies of all licenses and registrations must be submitted as well, unless stated otherwise in this chapter or in another CMS directive.
2. Site Visits
• Initial application – If a PXRS submits an initial application, the contractor shall order a site visit through the Provider Enrollment, Chain and Ownership System (PECOS) after the contractor receives the tie-in notice (or approval letter) from the RO but before the contractor conveys Medicare billing privileges to the PXRS. This is to ensure that the supplier is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The National Site Visit Contractor (NSVC) will perform the site visit. The contractor shall not convey Medicare billing privileges to the supplier prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• Revalidation – If a PXRS submits a revalidation application, the contractor shall order a site visit through PECOS. This is to ensure that the supplier is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not make a final decision regarding the revalidation application prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• New/changed location - If a PXRS is (1) adding a new location or (2) changing the physical location of an existing location, the contractor shall order a site visit of the new/changed location through PECOS after the contractor receives notice of approval from the RO but before the contractor switches the supplier’s enrollment record to “Approved.” This is to ensure that the new/changed location is in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not switch the supplier’s enrollment record to “Approved” prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
3. Reassignment
PXRSs may receive reassigned benefits. A PXRS need not separately enroll as a group practice in order to receive them.
C. Additional Information
For more information on PXRSs, refer to:
• 42 CFR §§ 486.100 – 486.110
• Pub. 100-07, State Operations Manual, chapter 2, sections 2420 – 2424B
• Pub. 100-02, Benefit Policy Manual, chapter 15, sections 80.4 – 80.4.4
• Pub. 100-04, Claims Processing Manual, chapter 13, sections 90 – 90.5
See also sections 15.19.2.2 through 15.19.2.4 of this chapter for additional PXRS site visit information.
Pharmacies typically enroll with the National Supplier Clearinghouse via the Form CMS-855S. However, there are certain covered drugs that are billed through the physician fee schedule and not the schedule for durable medical equipment, prosthetics, orthotics and supplies. These drugs must be billed to the Part A/B Medicare Administrative Contractor (A/B MAC), meaning that the pharmacy must enroll with the A/B MAC via the Form CMS-855B.
For more information on the billing and coverage policies for Part B drugs, see:
• Pub. 100-04, Claims Processing Manual, chapter 17
• Pub. 100-02, Benefit Policy Manual, chapter 15, sections 50 through 50.6
15.4.2.5 - Portable X-Ray Suppliers (PXRSs)
(Rev. 561, Issued: 12-12-14, Effective: 03-18-15, Implementation: 03-18-15)
A. General Background Information
To qualify as a portable x-ray supplier (PXRS), an entity must meet the conditions for coverage discussed in 42 CFR § 486.100-110.
A PXRS can be simultaneously enrolled as a mobile IDTF, though they cannot bill for the same service. A PXRS requires a State survey, while a mobile IDTF does not (although an IDTF requires a site visit).
A PXRS does not have a supplier agreement.
B. Enrollment of PXRSs
1. Section 4 of the Application
In order to enroll as a PXRS, a supplier must complete a Form CMS-855B, undergo a State survey, and obtain RO approval. In Section 4 of the Form CMS-855B, the PXRS must furnish certain information, including:
• Whether it furnishes services from a “mobile facility” or “portable unit.” The former term typically describes a vehicle that travels from place to place to perform services inside the vehicle. Examples of such vehicles include mobile homes or trailers. A “portable unit” exists when a supplier transports medical equipment to a particular location. Unlike with mobile facilities, the equipment on a portable unit is separate from and unattached to the vehicle.
• A PXRS can be either a mobile facility or portable unit, although it usually is the latter. A mobile IDTF, on the other hand, while it too can be either, is typically a mobile facility.
• Its base of operations. This is where personnel are dispatched from and where equipment is stored. It may or may not be the same address as the practice location.
• All geographic locations at which services will be rendered.
• Vehicle information if the services will be performed inside or from the vehicle. Copies of all licenses and registrations must be submitted as well, unless stated otherwise in this chapter or in another CMS directive.
2. Site Visits
• Initial application – If a PXRS submits an initial application, the contractor shall order a site visit through the Provider Enrollment, Chain and Ownership System (PECOS) after the contractor receives the tie-in notice (or approval letter) from the RO but before the contractor conveys Medicare billing privileges to the PXRS. This is to ensure that the supplier is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The National Site Visit Contractor (NSVC) will perform the site visit. The contractor shall not convey Medicare billing privileges to the supplier prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• Revalidation – If a PXRS submits a revalidation application, the contractor shall order a site visit through PECOS. This is to ensure that the supplier is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not make a final decision regarding the revalidation application prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• New/changed location - If a PXRS is (1) adding a new location or (2) changing the physical location of an existing location, the contractor shall order a site visit of the new/changed location through PECOS after the contractor receives notice of approval from the RO but before the contractor switches the supplier’s enrollment record to “Approved.” This is to ensure that the new/changed location is in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not switch the supplier’s enrollment record to “Approved” prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
3. Reassignment
PXRSs may receive reassigned benefits. A PXRS need not separately enroll as a group practice in order to receive them.
C. Additional Information
For more information on PXRSs, refer to:
• 42 CFR §§ 486.100 – 486.110
• Pub. 100-07, State Operations Manual, chapter 2, sections 2420 – 2424B
• Pub. 100-02, Benefit Policy Manual, chapter 15, sections 80.4 – 80.4.4
• Pub. 100-04, Claims Processing Manual, chapter 13, sections 90 – 90.5
See also sections 15.19.2.2 through 15.19.2.4 of this chapter for additional PXRS site visit information.
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