Jane Dotson
Medicare DME MAC Jurisdiction C, also known as JC, is a Medicare Administrative Contractor (MAC) that processes FFS Medicare DME claims for a defined group of states and territories in the US. MACs are private healthcare insurers that process Medicare Part A and Part B claims for institutional providers, physicians, practitioners, and suppliers within their specific jurisdictions. There are currently 4 DME MACs in the program, and JC serves Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, the US Virgin Islands, Virginia, and West Virginia.
| Characteristics | Values |
|---|---|
| Full Form | DME MAC Jurisdiction C |
| What it is | A Medicare Administrative Contractor (MAC) |
| What it does | Processes FFS Medicare DME claims |
| Where it is applicable | Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia |
| Total Number of Fee-for-Service Beneficiaries | 12,036,235 (as of 9/30/2023) |
| Total Number of Suppliers | 29,488 (as of 9/30/2023) |
| Total Annual Claims Volume | 36.5% of the national DME workload (as of 9/30/2023) |
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What You'll Learn
DME MAC Jurisdiction C covers 16 US states and territories
DME MAC Jurisdiction C is serviced by CGS and covers 16 US states and territories. A Medicare Administrative Contractor (MAC) is a private health care insurer that processes Medicare FFS claims. There are 12 A/B MACs and 4 DME MACs in the program, which collectively process more than 1.1 billion Medicare FFS claims.
The DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or "jurisdiction", servicing suppliers of DMEPOS. DME MAC Jurisdiction C covers the following states: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. It also covers Puerto Rico and the US Virgin Islands.
It is important to note that the four HH+H areas do not coincide with the jurisdictional areas covered by the four A/B MACs. Suppliers must submit claims to the DME MAC that serves the state or territory where the Medicare beneficiary permanently resides. For example, if a supplier is located in California but provides services to a beneficiary who lives in Minnesota for eight months and California for four months, the supplier must submit the claim to Jurisdiction B, where the beneficiary lives most of the year.
The use of CDT-4 and CPT is limited to programs administered by the Centers for Medicare & Medicaid Services (CMS) and is authorized only for internal use within an organization and its employees and agents. Any unauthorized use, such as resale or transfer to an unauthorized party, is prohibited.
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It processes FFS Medicare DME claims
A Medicare Administrative Contractor (MAC) is a private healthcare insurer that processes Medicare FFS claims. There are 12 A/B MACs and 4 DME MACs in the program that process Medicare FFS claims for over 50% of the total Medicare beneficiary population, which is approximately 34 million people. In Fiscal Year 2023 (FY2023), the MACs served more than 1.2 million healthcare providers enrolled in the Medicare FFS program.
DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or "jurisdiction", servicing suppliers of DMEPOS. DME MAC Jurisdiction C includes the states of California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands.
The Durable Medical Equipment (DME) file contains fee-for-service claims submitted by Durable Medical Equipment suppliers to the DME Medicare Administrative Contractor (MAC). The DME file includes the diagnosis, services provided, dates of service, charge, reimbursement amounts, supplier provider number, and supplier NPI.
Providers submit claims to CMS to be reimbursed for services provided to fee-for-service (FFS) beneficiaries. For Medicare beneficiaries with FFS coverage, claims data are available for two cohorts: persons with and without cancer. For beneficiaries with cancer, the Home Health Agency file contains 100% of all claims for home health services. This file includes the number of visits, type of visit, diagnosis, dates of visits, reimbursement amount, HHA provider number, and beneficiary demographic information.
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DME MACs are private health care insurers
DME MAC stands for Durable Medical Equipment Medicare Administrative Contractor. A Medicare Administrative Contractor (MAC) is a private healthcare insurer. There are 4 DME MACs in the program that processes Medicare FFS claims for 34 million Medicare FFS beneficiaries, which is 51% of the total Medicare beneficiary population.
DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or "jurisdiction", servicing suppliers of DMEPOS. There are four A/B MACs that process home health and hospice claims in addition to their typical Medicare Part A and Part B claims. However, the four HH+H areas do not coincide with the jurisdictional areas covered by the four A/B MACs.
DME MAC Jurisdiction C (JC) processes FFS Medicare DME claims for Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, the U.S. Virgin Islands, Virginia, and West Virginia. As of 30 September 2023, the total number of fee-for-service beneficiaries was 12,036,235, the total number of suppliers was 29,488, and the total annual claims volume was 36.5% of the national DME workload.
It is important to note that claims for patients with Medicare Part C must be filed with the contractor of that plan and not with an A/B MAC or DME MAC.
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DME MAC Jurisdiction C is administered by CGS Medicare
DME MAC Jurisdiction C processes FFS Medicare DME claims for Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, the U.S. Virgin Islands, Virginia, and West Virginia. As of 30 September 2023, the total number of fee-for-service beneficiaries was 12,036,235, the total number of suppliers was 29,488, and the total annual claims volume was 36.5% of the national DME workload.
The use of CDT-4 is limited to use in programs administered by the Centers for Medicare & Medicaid Services (CMS) and is authorized for internal use by employees and agents within the United States and its territories. Any use not authorized is prohibited, including making copies of CDT for resale and/or license, transferring copies to any party not bound by the agreement, and creating any modi.
Medical Insurance (Part B) helps pay for medically necessary services by a physician, outpatient hospital services, home health care, and several other medical services and supplies that are not covered by Part A, including durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
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DME MAC Jurisdiction C processed 36.5% of the national DME workload as of 9/30/2023
A Medicare Administrative Contractor (MAC) is a private healthcare insurer that processes Medicare FFS claims. There are 12 A/B MACs and 4 DME MACs in the program that process Medicare FFS claims for nearly 51% of the total Medicare beneficiary population, approximately 34 million Medicare FFS beneficiaries.
DME MAC Jurisdiction C (JC) processed 36.5% of the national DME workload as of 30th September 2023. This jurisdiction includes the states of Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, the U.S. Virgin Islands, Virginia, and West Virginia. As of the same date, the total number of fee-for-service beneficiaries was 12,036,235, with 29,488 suppliers.
The DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or "jurisdiction", servicing suppliers of DMEPOS. DMEPOS refers to durable medical equipment, prosthetics, orthotics, and supplies. These are medically necessary services or supplies that are not covered by Part A of Medical Insurance (which helps pay for physician services, outpatient hospital services, and home healthcare).
In Fiscal Year 2023, the MACs collectively processed more than 1.1 billion Medicare FFS claims and paid out approximately $431.5 billion in Medicare FFS benefits.
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Frequently asked questions
MAC stands for Medicare Administrative Contractor. A MAC is a private healthcare insurer.
DME MAC Jurisdiction C (JC) processes FFS Medicare DME claims for 16 states and territories in the US: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, US Virgin Islands, Virginia, and West Virginia.
DME stands for Durable Medical Equipment.
FFS stands for Fee-for-Service.
