DMEPOS Covered Drugs

Drugs used with DME (eg, inhalation drugs, drugs infused with a DME pump) are not items that are subject to the Centers for Medicare and Medicaid Quality Standards/accreditation.  Also, other Part B drugs identified in section 1861 (s) of the Social Security Act (Act) (eg, immunosuppressive drugs, oral anti-emetic drugs) are not subject to the quality standards.

However, home dialysis supplies, nutrients furnished using enteral or parenteral devices, blood products, and transfusion medicine are subject to the quality standards.  Also, DME (but not DME drugs) and other items identified below are subject to the quality standards.

Specifically, if a pharmacy only dispenses Part B drugs and does not furnish any other items listed below (such as enteral or parenteral nutrients), it would not have to be accredited.

Items Subject to Quality Standards

1. All DME described in 1834(a)(13) and paid in accordance with 1834(a) but not including drugs or implantable items furnished by an outpatient hospital department that are not paid for in accordance with section 1861(n) of the Act. The term DME is defined at section 1861(n) of the Act.
2. Prosthetic devices, orthotics and prosthetics described in 1834(h)(4).

Prosthetic devices except it does not include parenteral and enteral (however, parenteral and enteral are subject to the quality standards because they are referenced in 1842(s)(2) as indicated below) and does not include implantable items paid for in an outpatient hospital department

Orthotics (braces), prosthetics (artificial limbs) and diabetic shoes but does not include intraocular lenses or medical supplies (eg, catheters, catheter suppliers, ostomy bags, and supplies) furnished by a Home Health Agency (HHA) (Note:  these items are bundled into the HHA prospective payment system).

3. Additional items referenced in section 1842(s)(2):
   1. Medical Supplies
   2. Home dialysis supplies and equipment
   3. No items listed
   4. Parenteral and enteral
   5. Electromyogram devices (currently not covered)
   6. Salivation devices (currently not covered)
   7. Blood products
   8. Transfusion Medicine

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