Glossary / DME MAC
DME MAC Durable Medical Equipment Medicare Administrative ContractorDME MAC (Durable Medical Equipment Medicare Administrative Contractor)
One of the two private contractors, Noridian or CGS, that process Medicare DMEPOS claims and prior authorizations across a four-jurisdiction map.
A Medicare Administrative Contractor (MAC) is a private company CMS contracts to process Medicare fee-for-service claims for a defined geographic jurisdiction. Durable medical equipment, prosthetics, orthotics, and supplies have their own contractors: four DME MAC jurisdictions, A through D, alongside the twelve A/B MAC jurisdictions that handle hospital and physician claims.
Two companies hold all four DME contracts. Noridian Healthcare Solutions administers Jurisdiction A (the Northeast and Mid-Atlantic) and Jurisdiction D (the West, the Mountain states, and the Pacific territories). CGS Administrators handles Jurisdiction B (the Great Lakes states) and Jurisdiction C (the South, Texas, Colorado, New Mexico, Puerto Rico, and the U.S. Virgin Islands).
Your DME MAC is who receives your prior authorization requests, issues ADRs, runs prepayment review and TPE, and publishes the supplier manual and documentation checklists you are held to. Each MAC also runs a portal (the Noridian Medicare Portal or myCGS) for eligibility, claim status, and document submission.
Common questions
How do I know which DME MAC to bill?
By the beneficiary's permanent address on file with the Social Security Administration, not by the supplier's location. See the jurisdiction entry for the state map.
Are the coverage rules different between Noridian and CGS?
The LCDs and policy articles are joint DME MAC policies, so the coverage criteria are the same in all four jurisdictions. Portals, forms, contact channels, and some educational guidance differ.
Related
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Sources: CMS: Who are the MACs · CMS: MACs by state · Noridian JD DME: Claim denials for incorrect jurisdiction . Definitions summarize public Medicare policy and are not legal or billing advice.
More terms
- ADR — Additional Documentation Request
- Prior authorization
- Affirmation and non-affirmation
- UTN — Unique Tracking Number
- SWO — Standard Written Order
- Face-to-face encounter
- Jurisdiction
- PTAN — Provider Transaction Access Number
- NPI — National Provider Identifier
- MBI — Medicare Beneficiary Identifier
- LCD — Local Coverage Determination
- NCD — National Coverage Determination
- Policy article
- HCPCS — Healthcare Common Procedure Coding System
- Length of need
- Prior authorization exemption
- Competitive bidding
- CMN and DIF — Certificate of Medical Necessity and DME Information Form
- Proof of delivery
- TPE — Targeted Probe and Educate
- Prepayment review