Summary
- Change Request (CR) 13658 updates the DMEPOS fee schedule to implement new and existing codes and apply changes in payment policies.
- Effective Date: July 1, 2024 (except for HCPCS codes E2298 and K1007, effective April 1, 2024).
- Implementation Date: July 1, 2024.
Background
- The update process for the DMEPOS fee schedule is detailed in the Medicare Claims Processing Manual, chapter 23, section 60.
- Fee schedule updates are required for certain DME, prosthetic devices, orthotics, and surgical dressings as mandated by the Social Security Act.
- Updates include national payment amounts for lymphedema compression treatment items, adjustments to fee schedule amounts for DME items included in the DMEPOS Competitive Bidding Program (CBP), and new payment amounts based on competitive bidding information.
Key Points
- Consolidated Appropriations Act, 2023: This Act continues the fee schedule amount adjustments for items in non-rural contiguous non-Competitive Bidding Areas based on a blend of adjusted and unadjusted fee schedule amounts until the end of 2023.
- Gap Period in DMEPOS CBP: Effective January 1, 2024, due to the expiration of Medicare Round 2021 DMEPOS CBP contracts for certain items.
- Payment During Gap Period: Payments for items and services previously included in the CBP are based on the Single Payment Amounts (SPAs) increased by the Consumer Price Index Urban (CPI-U).
Updates
- No New Codes Added or Deleted: Effective July 1, 2024.
- Fee Schedule for HCPCS Code K1007: Payment amounts established and effective for claims on or after April 1, 2024.
- Revised Fee Schedule for HCPCS Code E2298: Corrected fee schedule calculations effective April 1, 2024.
Business Requirements
- Contractors must retrieve and use the updated DMEPOS fee schedule and Rural ZIP code files to pay claims for items with dates of service beginning July 1, 2024.
- Specific instructions are provided for processing and reprocessing claims for code E2298.
Provider Education
- CMS will develop and release national provider education content through the Medicare Learning Network (MLN) and market it via the MLN Connects newsletter.
For more detailed information and updates, you can visit the CMS website:
- DMEPOS Fee Schedule
- DMEPOS Competitive Bidding
- Healthcare Common Procedure Coding System