CurrentAnthemPolicy G-06081

Facility Take-Home DME and Medical Supplies, Reimbursement Policy

Governs reimbursement for durable medical equipment (DME) and medical supplies dispensed by inpatient or outpatient hospital facilities for take-home use under Anthem Medicare Advantage for listed states; specifies when facility claims will be denied and when reimbursement is allowed.

Policy Summary

PayerAnthem

PolicyFacility Take-Home DME and Medical Supplies, Reimbursement Policy

Policy CodePolicy G-06081

Change TypeReview approvedno material changes

Effective DateMay 22, 2024

Next Review Date

Key ActionSubmit claims for take-home DME and supplies through a DME/supply vendor; facility claims billed with take-home revenue codes will be denied.

SourceLink

POLICY UPDATE CHANGES

Review approved and effective: no changes.

Policy language updated on 10/18/2019.

2explicitly allowed items/conditions

11Medicare Advantage states listed

G-06081policy identifier

Facility Take-Home DME and Supplies Coverage

Facility take-home DME and supplies

Facility take-home DME and supplies reimbursement rules

Facility claims for DME and medical supplies billed with revenue codes denoting take-home use will be denied unless provider, state, federal, or CMS contracts/requirements indicate otherwise.

Claims for take-home DME and medical supplies should be submitted by a DME/supply vendor; reimbursement is based on the contract or negotiated rate for participating vendors or the out-of-network fee schedule/negotiated rate for nonparticipating vendors.

Exceptions - facility claims allowed when billed with revenue codes other than take-home for:

Crutches.
No more than 72 hours of medical supplies if the provider was not able to obtain supplies from a vendor by discharge.

Policy Summary

PayerAnthem

PolicyFacility Take-Home DME and Medical Supplies, Reimbursement Policy

Policy CodePolicy G-06081

Change TypeReview approvedno material changes

Effective DateMay 22, 2024

Next Review Date

Key ActionSubmit claims for take-home DME and supplies through a DME/supply vendor; facility claims billed with take-home revenue codes will be denied.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Billing and Allowable Supply Guidance

Billing code guidancemixed

No codes listed

Allowable facility-dispensed supplies at discharge

Allowed take-home itemCrutches dispensed to the member at discharge are allowable on facility claims when billed with revenue codes other than take-home.

Temporary supplies allowanceNo more than 72 hours of medical supplies may be dispensed at discharge if the provider could not obtain supplies from a vendor by discharge.

Vendor unavailability conditionThe 72-hour supplies exception applies only when the provider was not able to obtain supplies from a vendor by the time of discharge.

Billing requirement for allowanceThese items must be billed on facility claims with revenue codes other than take-home to be eligible for reimbursement.

Reimbursement pathwayIf not meeting the discharge exceptions, claims for take-home DME and medical supplies should be submitted by a DME/supply vendor for reimbursement.

Submission, Denial, and Billing Actions for Facilities

Denial Risk

Submission and Denial Guidance

Providers must follow proper billing and submission guidelines. Use industry-standard, compliant codes on all claim submissions (CPT, HCPCS, and/or revenue codes). Services billed must be fully supported in the medical record and/or office notes. Facility claims submitted for take-home durable medical equipment (DME) and medical supplies billed with revenue codes denoting take-home use will be denied. To be considered for reimbursement, claims for take-home DME and medical supplies should be submitted by a DME/supply vendor. Reimbursement for vendor-submitted claims is based on the contract or negotiated rate for participating vendors, or the out-of-network fee schedule or negotiated rate for nonparticipating vendors.

Use CPT, HCPCS, and/or revenue codes and ensure documentation supports billed services.
Facility take‑home DME and medical supplies billed with take‑home revenue codes will be denied.
Submit take‑home DME and medical supplies claims through a DME/supply vendor for reimbursement.
Reimbursement for vendor claims follows contract/negotiated rates (participating) or out‑of‑network fee schedules (nonparticipating).
Facilities may bill for crutches and up to 72 hours of medical supplies dispensed at discharge if the provider could not obtain supplies from a vendor by discharge — use revenue codes other than take‑home.

OpenPayer

Facility Take-Home DME and Medical Supplies, Reimbursement Policy

Facility Take-Home DME and Supplies Coverage

Billing and Allowable Supply Guidance

Submission, Denial, and Billing Actions for Facilities

Key Terms