Baltimore -- Medicare billers who want to know whether certain durable medical equipment would be covered under Medicare now must submit to a durable medical equipment regional carrier an advance determination of Medicare coverage, formerly known as a prior authorization.

According to the Health Care Financing Administration, the DMERCs must, at the request of a provider or beneficiary, determine in advance of delivery of an item whether it would be covered by Medicare. However, a provider can file an ADMC only if the equipment in question meets at least one of the following criteria: it's customized, the patient to whom the item is being furnished or the provider requests an advance determination, or the Health and Human Services secretary specifies the item as expensive.

HCFA said the program is voluntary, and beneficiaries and providers need not submit ADMC requests in order to submit claims for items. Also, DMERCs can't require submission of an ADMC as a prerequisite for filing a claim.

For HCFA's complete notice on ADMCs, go to www.hcfa.gov/pubforms/transmit/r5pim.pdf on the Internet.