Introduction The Centers for Medicare & Medicaid Services (CMS) has issued an update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) effective from July 1, 2024. This update provides instructions for updating the DMEPOS CBP files, including changes to the Healthcare Common Procedure Coding System (HCPCS), ZIP code, and single payment amount files.

Key Updates

1. Effective Date And Implementation
   • Changes are effective from July 1, 2024.
   • Implementation date is also July 1, 2024.
2. Background
   • The DMEPOS CBP was mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
   • The program aims to replace the current fee schedule payment methodology for selected DMEPOS items with a competitive bidding process to reduce costs and ensure access to quality items and services.
   • Previous rounds of the CBP have been conducted since 2011, with adjustments and temporary gaps in the program.
3. Policy Changes
   • Quarterly updates to the DMEPOS CBP files include the CBA ZIP code file, HCPCS file, and CBA pricing file.
   • During temporary gap periods, any Medicare enrolled DMEPOS supplier may furnish any DMEPOS item.
   • Payment for items is based on the lower of the supplier’s charge or adjusted fee schedule amounts.

Business Requirements

1. File Updates
   • The Competitive Bidding Implementation Contractor (CBIC) will generate updated files quarterly and transmit them to the Virtual Data Center (VDC).
   • The VDC will retrieve and automate the process for refreshing these files, which will then be loaded by the DME MACs and PDAC contractor.
2. Technical Directions
   • DME MACs will receive technical direction on when the temporary gap period will end.
   • VDC will receive notice if dataset names for files are changed.

Provider Education

• CMS will provide necessary education and resources to help providers and suppliers understand and implement these updates.

Conclusion This quarterly update ensures that the DMEPOS Competitive Bidding Program remains current and effective in setting sustainable prices and ensuring access to quality medical equipment and supplies. By adhering to these updates, suppliers can maintain compliance and support the goals of the Medicare program.