Manual Update Pub. 100-02 Medicare Benefit Policy, Chapter 15, Section 110.8 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Benefit Category Determinations

  1. Updates And Effective Dates:
    • Effective January 1, 2024, for 3 orthotic brace determinations.
    • Effective April 1, 2024, for all other items, equipment, and devices.
  2. Implementation Date:
    • July 15, 2024.
  3. Manual Changes:
    • The document specifies updates to Pub. 100-02, Chapter 15, Section 110.8 regarding DMEPOS Benefit Category Determinations.
  4. Funding For MACs:
    • Medicare Administrative Contractors (MACs) are advised that this constitutes technical direction as defined in their contract. Contractors should not incur costs exceeding their contract allotments unless specifically authorized.
  5. Provider Education:
    • CMS will develop national provider education content and market it through the Medicare Learning Network® (MLN). MACs are to link to relevant information and distribute the newsletter to providers.
  6. Specific Updates To DMEPOS Categories:
    • The document provides a detailed list of items, their benefit category determinations, and their effective dates. Examples include prosthetic devices, orthotic devices, and DME items such as powered pressure-reducing underlays, neuromodulation stimulators, and various types of prosthetic legs and arms.
  7. Business And Provider Education Requirements:
    • Tables are provided outlining the responsibilities of various contractors (e.g., A/B MACs, DME MACs) regarding awareness and implementation of these updates.
  8. Supporting Information:
    • Additional recommendations and supporting information are provided for the listed requirements.
  9. Contacts And Funding:
    • Post-implementation contacts are listed, advising contractors to contact their Contracting Officer’s Representative (COR) for guidance.
  10. Detailed List of DMEPOS Items and Categories:
  • The document includes a comprehensive list of DMEPOS items, their benefit category determinations, and effective dates, such as complex rehabilitative power wheelchair accessories, adhesive clips for nerve stimulator controllers, and electronic positional obstructive sleep apnea treatment equipment.

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