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Health Status Monitoring

All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program contracts expired on December 31, 2018. As of January 1, 2019, there is a temporary gap in the entire DMEPOS Competitive Bidding Program that CMS expects will last until December 31, 2020. For additional information, please see the Temporary Gap Period fact sheet.

On January 1, 2011, the Centers for Medicare & Medicaid Services (CMS) launched the first phase of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program in nine different areas of the country. In order to protect the interests of potentially affected Medicare beneficiaries, CMS has been conducting real-time claims analysis to monitor health status for groups of Medicare beneficiaries in competitive bidding areas (CBAs). Health status results are shown in the files on this page. Each file includes a written summary of results and graphical displays of key indicators reflective of the health status of beneficiaries and their access to DMEPOS items and services. The data is derived from claims for Medicare populations in each CBA and a corresponding "comparator" region that is similar to the CBA. CMS initially published monthly updates to this information. Because the first full year of data indicated no change in beneficiary health status outcomes resulting from the competitive bidding program, CMS is now issuing quarterly updates. See the Downloads section below for the latest results.

Note:  Since the implementation of the ICD-10 code set on October 1, 2015, CMS has released ICD-10 code updates on a fiscal year basis. The ICD-10 code updates incorporate new diagnosis codes and/or remove retired diagnosis codes. These updates, as well as any adjustments to existing diagnosis code pairs, may result in changes to the General Equivalence Mappings (GEMs), which is a tool used to convert ICD-9 codes to ICD-10 codes and vice versa. 

Beginning with the fourth quarter of 2017, the public use files have been updated to incorporate the new ICD-10 codes that are related to the following populations: commode chairs access group, diabetes access group, oxygen access group, standard wheelchairs access group, TENS access group, and walkers access group. In addition, beginning with the second quarter of 2018, the public use files have been updated to incorporate additional ICD-10 codes that are related to the following populations: commode chairs access group, diabetes access group, hospital beds access group, NPWT access group, patient lifts access group, seat lifts access group, standard wheelchairs access group, TENS access group, and walkers access group. A comprehensive listing of all ICD-10 codes can be found in the “Downloads” section below.

Downloads

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