Effective Date: January 1, 2024
Implementation Date: January 2, 2024
Purpose:
Annual update to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule. This includes new and existing codes and changes in payment policies as detailed in the Medicare Claims Processing Manual, Chapter 23, Section 60.
Key Updates:
- New Payment Amounts:
- Implemented for new and existing DMEPOS codes.
- Includes national payment amounts for lymphedema compression treatment items as per Section 1834(z) of the Social Security Act and 42 CFR §414.1650.
- Adjustments Based on Competitive Bidding Program (CBP):
- Adjustments for DME items outside CBP areas.
- Off-the-shelf orthotics and enteral nutrition adjustments based on CBP data.
- Consolidated Appropriations Act, 2023:
- Extended fee schedule adjustments for non-rural, non-CBP areas through December 31, 2023.
- Post January 1, 2024, fee schedules are fully adjusted per §414.210(g).
- DMEPOS Competitive Bidding Gap Period:
- Contracts for certain items expired on December 31, 2023.
- During the gap, payments are 80% of the supplier’s charge or the fee schedule amount.
- Rural and Non-Contiguous Area Adjustments:
- ZIP codes determine rural fee schedule applicability.
- Updated quarterly as needed.
- New HCPCS Codes:
- Transition of temporary codes to permanent status.
- Lymphedema compression items included with specific payment guidelines.
Important Files Updated:
- DMEPOS fee schedule for 2024.
- DMEPOS Rural ZIP code file (Q1 2024).
- Parenteral and Enteral Nutrition fee schedule.
- Former CBA Fee schedule and ZIP Code files.
- National Mail Order diabetic testing supply fee schedule.
Payment Methodology for New Items:
- Based on Medicaid state plan payments or average internet retail prices if Medicaid data is unavailable.
- Annual updates tied to the Consumer Price Index.
