Glossary

DME MACDurable Medical Equipment Medicare Administrative Contractor

The regional contractors that process Medicare claims for durable medical equipment and supplies, and that publish the coverage rules those claims are judged against. Two companies hold the four jurisdictions: Noridian in JA and JD, CGS in JB and JC.

DMEPOSDurable Medical Equipment, Prosthetics, Orthotics and Supplies

The Medicare benefit category the codes on this hub are billed under. Its quarterly fee schedule is published by CMS and states the Medicare allowable for each code by jurisdiction, which is the benchmark every other figure on this site is read against.

Ghost rates

Rows in a machine-readable file that price a code for a provider who does not bill it. A file can carry a rate for a provider who has never supplied the item, so a row existing is not evidence that the code is billed or paid there. Also called zombie rates.

HCPCSHealthcare Common Procedure Coding System

The code set Medicare and most other payers use to identify items and services. Level II covers supplies and equipment rather than physician work, and the nine A-codes documented on this hub are all Level II.

LCDLocal Coverage Determination

A DME MAC statement of when an item is covered in its jurisdiction, published with a companion policy article that carries the coding and documentation detail. L33803 and A52521 govern urological supplies; L36267 and A54516 govern bowel management.

Where a page on this hub and the governing determination disagree, the determination is right and the page is wrong.

MRFMachine-Readable File

A rate file a payer publishes under the Transparency in Coverage rule. The in-network-rates file is the one that carries prices; an allowed-amounts file and a provider-reference file sit beside it. They are compressed JSON, and one payer month is commonly large enough that no ordinary desktop tool will open it.

PDACPricing, Data Analysis and Coding contractor

The CMS contractor that decides which HCPCS code a particular product is billed under, and records that decision in its product classification list. Where a code requires PDAC verification, a product may be billed under it only once the contractor has classified it there.

Prosthetic benefit

The Medicare benefit category these codes fall under. It is not capped rental, so coverage continues once it has been established, and audits concentrate on the documentation held and on the monthly quantity ceilings rather than on a rental clock.

SWOStandard Written Order

The order a supplier must hold on file before it bills Medicare for an item. The January 1, 2026 code split required a new order only where the existing order named a HCPCS code, which meant A4351, A4352 or A4353. An order written with a general description such as hydrophilic catheter, or with a brand and model, needed no replacement, and the supplier simply bills the new code for dates of service on or after January 1, 2026.

Stated by Noridian Healthcare Solutions, jurisdictions JA and JD, July 17, 2025

TAITransanal irrigation

A bowel management method in which water is instilled into the rectum and lower colon through a catheter or a cone, so that the bowel empties on a schedule rather than unpredictably. It is the procedure behind the bowel management codes documented on this hub.

TiCTransparency in Coverage

The federal rule requiring health plans and insurers to publish machine-readable files of their negotiated in-network rates, refreshed every month. It is the rule the provenance line at the foot of every page on this site refers to.

TOCTable of Contents

The index file listing where a payer has put its machine-readable files for a given month. It is far smaller than the files it points at, and reading a payer month starts here, because nothing else states which files exist.