DMEPOS Archive

2021 Final Rule Changes

We issued the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) final rule (CMS-1738-F, CMS-1687-F, and CMS-5531-F), which updated payment and benefit category policies and other provisions for DMEPOS items. View a summary of key provisions.

2021 Oxygen & Oxygen Equipment Changes

As of April 1, 2021, section 121 of the Consolidated Appropriations Act (CAA) eliminated the budget neutrality requirement set forth in section 1834(a)(9)(D)(ii) of the Act for separate classes and national limited monthly payment rates established for any item of oxygen and oxygen equipment using the authority in section 1834(a)(9)(D)(i) of the Act. Effective for claims with dates of service on or after April 1, 2021, the fee schedule amounts for HCPCS codes E0424, E0431, E0433, E0434, E0439, E0441, E0442, E0443, E0444, E0447, E1390, E1391, E1392, E1405, E1406, and K0738 are adjusted to remove a percentage reduction necessary to meet the budget neutrality requirement previously mandated by section 1834(a)(9)(D)(ii) of the Act.

These adjustments resulted in an increase in fee schedule amounts ranging from $6.72 to $8.19 in former competitive bidding areas, $5.17 to $5.43 in other non-rural areas, and $4.41 to $6.82 in noncontiguous and rural areas.

2019 Oxygen & Oxygen Equipment Payment Calculations

We published a final rule in the Federal Register on November 14, 2018 (83 FR 56992), which established new and separate payment classes for portable liquid oxygen equipment, portable gaseous oxygen equipment, and high flow portable liquid oxygen contents beginning January 1, 2019. It established a new methodology for ensuring that all new payment classes for oxygen and oxygen equipment are budget neutral in accordance with section 1834(a)(9)(D)(ii) of the Act. This included a separate, higher-paying class for oxygen generating portable equipment, as well as separate classes for delivery of portable and stationary portable oxygen contents created in 2006. The initial methodology for achieving the annual budget neutrality of these separate payment classes was established through notice and comment rulemaking, and the final rule was published in the Federal Register on November 9, 2006 (71 FR 65884). View the worksheets that calculate the budget neutrality factors (ZIP).

2018 Payment for PEN

On November 14, 2018, we published a final rule that affected the 2019 and 2020 DMEPOS and parenteral and enteral nutrition (PEN) fee schedules. We published corrections on December 28, 2018, in CMS-1691-CN. This rule established a methodology for adjusting fee schedule amounts for certain items using information from the DMEPOS Competitive Bidding Program (CBP) for items furnished from January 1, 2019 – December 31, 2020. This final rule implemented the requirements of section 16008 of the 21st Century Cures Act (for calendar years 2019 and 2020 only), which required that certain information be considered in making fee schedule adjustments using competitive bidding information for items furnished on or after January 1, 2019. The rule adjusted fee schedule amounts in rural and non-contiguous areas where competitive bidding has yet to be implemented using a 50/50 blend of competitive bidding pricing and historic (“unadjusted”) fee schedule amounts. The fee schedule amounts for other areas where competitive bidding has yet to be implemented are adjusted using competitive bidding pricing only. The rule also adjusts fee schedule amounts for former competitive bidding areas using competitive bidding pricing when there is a gap in the DMEPOS CBP.

This final rule also establishes new payment classes for portable liquid oxygen equipment, portable gaseous oxygen equipment, and high flow portable liquid oxygen contents. It establishes a new methodology for ensuring that all new payment classes for oxygen and oxygen equipment are budget neutral in accordance with section 1834(a)(9)(D)(ii) of the Act. Finally, this rule establishes special payment rules for multi-function ventilators, revises the payment methodology for mail order items furnished in the Northern Mariana Islands, and includes a summary of the feedback we received for a request for information related to establishing fee schedule amounts for new DMEPOS items and services.

2017 CGM Information

We issued a ruling on January 12, 2017, concluding that certain continuous glucose monitors (CGMs), referred to as therapeutic CGMs, approved by the Food and Drug Administration for use in making diabetes treatment decisions are considered DME. 

2016 Cures Act

Section 16007(a) of the 2016 21st Century Cures Act (the Cures Act) extended the 6-month phase in period for adjusting DMEPOS fee schedule amounts using information from the CBP from June 30, 2016  – December 31, 2016. The fee schedule amounts paid during this 2016 phase in period are based on 50% of the fee schedule amounts adjusted in accordance with Federal regulations at 42 CFR 414.210(g) and 50% of the unadjusted fee schedule amounts (for example, 2015 fee schedule amounts updated by the 2016 covered item update). The statute and regulations specify that we must adjust the fee schedule amounts (50% of the blended phase in rates) each time new pricing information from the CBP becomes available, such as the recompeted Round 2 payment amounts that took effect on July 1, 2016. Therefore, the blended phase in rates used to pay claims for items furnished from January 1, 2016 – June 30, 2016, are different than the blended phase in rates used to pay claims for items furnished from July 1, 2016 – December 31, 2016, since the adjusted fee portion was updated on July 1, 2016, in accordance with section 1834(a)(1)(F)(iii) of the Social Security Act. View the revised blended fee schedule public use files for payment of claims from July 1, 2016 – December 31, 2016.

We issued Transmittal 3716, Change Request 9968 titled “Extension of the Transition to the Fully Adjusted Durable Medical Equipment, Prosthetics, Orthotics and Supplies Payment Rates under Section 16007 of the 21st Century Cures Act” on February 10, 2017. This instruction provides contractor requirements for the implementation of section 16007 for claims with dates of service from July 1, 2016  –  December 31, 2016.

DME Requirements Changes

In CMS-1526-P, we:

• Clarified the 3-year minimum lifetime requirement (MLR) for DME and the definition of routinely purchased DME
• Proposed the implementation of budget-neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician’s office

Proposed technical amendments and corrections to existing regulations related to payment for DMEPOS items and services in the End-Stage Renal Disease Prospective Payment System Proposed Rulemaking