Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program – Updates and Important Information

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program – Updates and Important Information

This fact sheet was updated on December 8, 2025

The Centers for Medicare & Medicaid Services (CMS) is making some important changes in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) so that we can protect the Medicare Trust Funds and lower copays for beneficiaries. For more details, refer to the Calendar Year (CY) 2026 Home Health Prospective Payment System Final Rule (CMS-1828-F) displayed in the Federal Register on November 28, 2025.

Next Round Timeline

To ensure bidders are prepared for the next round, CMS has announced the following next steps for the program:

*December 2025

• CMS begins pre-bidding supplier awareness program 

*Late Spring/Early Summer 2026

• CMS announces specific dates for registration and bidding
• CMS announces lead items for the DMEPOS CBP product categories and number of contracts to award for each product category
• CMS begins bidder education program

*Late Summer/Early Fall 2026

• Bidder registration period to obtain user IDs and passwords begins
• Bid window opens

*Late Summer/Early Fall 2027

• Contracts awarded and single payment amounts announced
• Beneficiary education begins

*No Later Than January 1, 2028

• Start of Next Round - Contracts and single payment amounts (SPAs) in effect
• Six-month transition period begins for beneficiaries to switch to contract suppliers

 *Dates listed are target dates

Next Round DMEPOS CBP Product Categories

• Class II Continuous Glucose Monitors (CGMs) and Insulin Pumps
• Urological Supplies[1]
• Ostomy Supplies
• Hydrophilic Urinary Catheters
• Off-The-Shelf (OTS) Back Braces
• OTS Knee Braces
• OTS Upper Extremity Braces

*All product categories for the next round will be included in the Nationwide Remote Item Delivery Program.

For beneficiaries transitioning from non-contract suppliers to contract suppliers during the initial three months of the contract period, if the non-contract supplier does not transfer the beneficiary’s medical necessity documentation to the contract supplier, then the contract supplier has six months to obtain new orders from the patient’s physician or treating practitioner. As part of this transition, contract suppliers must furnish the brand of items ordered by the patient’s physician in compliance with the physician authorization process and DMEPOS supplier standards.  This six-month grace period does not apply to the purchase of OTS braces, as these items will not involve such transitions.

What’s New:

1. Modernization of the DMEPOS CBP Information Technology Systems

   As part of CMS’ continued process improvement efforts to streamline the bidding process, all the bidding-related information technology systems have been consolidated into one system, Connexion, CMS’ DMEPOS CBP secure portal. In past competitive bidding rounds, suppliers submitted bids (Form A and Form B) electronically through DBidS and all other documents through Connexion. Bidders will no longer have to log into two different systems to submit their bid information.

2. Single Payment Amounts 

   SPAs are now calculated using the 75th percentile of winning bids instead of the maximum winning bid. In addition, the SPAs are updated at the beginning of the second year and third year of the contract period by the percentage change in the Consumer Price Index for all Urban Consumers (CPI-U) for the 12-month period ending 6 months prior to the start of the second (and third year, if applicable) of the contract period. In no case can the updated SPA exceed the unadjusted fee schedule amount for the item or 110% of the adjusted fee schedule amount for the item.

3. Remote Item Delivery CBP

   A nationwide RID CBP is being phased into the DMEPOS CBP for items typically furnished on a national mail order basis. The nationwide RID CBP includes all areas (all states, territories, and the District of Columbia). Contract suppliers for each product category will be responsible for furnishing all items under the product category to all Medicare beneficiaries regardless of where they live. Only contract suppliers can furnish items included under the nationwide RID CBP that are covered under Medicare Part B. Unlike a national mail order program, the items included under a RID CBP may be shipped or delivered to a beneficiary’s home or may be picked up at a local pharmacy or storefront if the beneficiary or caregiver for the beneficiary chooses to pick up the items in person and the local pharmacy or storefront is owned by a contract supplier or a subcontractor of the contract supplier. 

4. Methodology for Determining the Number of RID CBP Contract Suppliers

   The number of contracts offered for each product category will be based on 125% of the number of suppliers furnishing at least 3% of total national allowed services for the lead item in 2025. Based on 2024 claims data, we believe this would result in approximately ten national contract suppliers for the CGM/insulin pump product category, eight national contract suppliers for the urological supplies and ostomy supplies product categories, six national contract suppliers for the OTS upper extremity braces and OTS knee braces product categories, and four national contract suppliers for the OTS back braces product category (note, the actual number of contract suppliers will be based on 2025 or 2026 claims data and will be announced in late Spring/early Summer 2026). If less than 30% of the winning suppliers are small suppliers, additional contracts may be offered towards the goal of meeting the 30% small supplier target.

5. Payment Rules for Continuous Glucose Monitors and Insulin Infusion Pumps

   Payment for CGMs and insulin infusion pumps will be made on a continuous, monthly rental basis with payment for all necessary supplies and accessories included in the monthly rental rates beginning on the first day of the contract period. Contract suppliers maintain ownership of the rental equipment and are allowed to bill for up to three months of rental in advance. Contract suppliers must furnish the brand of CGM or insulin pump ordered by the physician for the beneficiary. Beneficiaries who own their own CGM or insulin pump prior to the start of the contract period can continue to use their equipment until it needs to be replaced or they elect to switch to a rented device. Contract suppliers must furnish replacement supplies and accessories for the beneficiary-owned CGM or insulin pump.

6. Limit on Bid Amounts

   The bid amount submitted for the monthly rental of a class II CGMs, including all necessary supplies, cannot exceed the monthly fee schedule amount for the supplies for the class II CGM plus the average of the purchase fee schedule amounts for the class II CGM divided by 60. Using the 2025 fee schedule amounts, this would result in a bid limit of $272.69. This number will be updated by the 2026 update factor. 

   The bid amounts submitted for an OTS back brace or OTS knee brace identified as the lead item in the product category for 2025 cannot exceed the average of the 2026 nonrural fee schedule amounts for the item. The bid amounts submitted for the OTS upper extremity brace, urological supply, or ostomy supply identified as the lead item for each of these three product categories for 2025 cannot exceed the average of the 2026 fee schedule amounts for the item.

7. Revising the Submission of Financial Document Requirements

   Each bidding entity is now only required to submit a business credit report with a numerical credit score or rating, unless the bidding entity does not have a business credit report with a numerical credit score or rating because the entity has not been in operation long enough to generate a numerical score or rating. Bidding entities that are unable to generate a credit report with a numerical credit score or rating would be required to submit a business credit report showing no data or insufficient information to generate a credit score or rating, in addition to a personal credit report with a numerical credit score or rating from the bidding entity’s Authorized Official or Delegated Official listed in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). 

   CMS will provide detailed information regarding the credit report and numerical credit score and/or rating requirements for entity types in the Request for Bids Instructions, which will be published prior to the opening of the bid window for each round of the DMEPOS CBP.

8. Covered Document Review Date (CDRD) Evaluation and Notification Process 

   CMS is streamlining the evaluation and notification processes for missing covered document(s). CMS will no longer evaluate if a bidding entity was missing a covered document(s) by the CDRD and by the close of the bid window and will only determine if a bidding entity had a missing covered document by the close of the bid window. Once the evaluation is completed, CMS will continue notifying bidding entities, within 90 days of the CDRD, of the specific covered document(s) that was missing or provide confirmation that all applicable covered documents had been received by the close of the bid window. Bidding entities will continue to have 10 business days from receiving their notification to submit the missing covered document(s).

9. Bid Surety Bond Review Process 

   Pursuant to 42 CFR §414.412(g), bidders are required to obtain a bid surety bond in the amount of $50,000 for each competitive bidding area (CBA) for which they submit a bid^[2]. CMS promulgated in regulations the review process used in Round 2021 where we will review each bid surety bond to determine if there is a deficiency(ies) and allow bidders the opportunity to correct certain deficiencies by submitting a bid surety bond rider. Bidders will have a single, 10-business day timeframe to obtain and submit a bid surety bond rider correcting the deficiencies on the bid surety bond.

10. Tribal Exemption from Participating in the DMEPOS CBP

    Indian Health Service (IHS) and tribally operated Medicare enrolled providers and suppliers will no longer have to submit a bid and be awarded a DMEPOS CBP contract to provide items included in the DMEPOS CBP to American Indian/Alaska Native (AI/AN) Medicare beneficiaries who live in a CBA. IHS and tribally operated Medicare enrolled providers and suppliers will be paid by Medicare for providing services to AI/AN Medicare beneficiaries who reside in a CBA, and AI/AN Medicare beneficiaries residing in a CBA will be able to retain their benefits from receiving services from Health Services and tribally operated providers and suppliers. 

11. Addition of a Termination Clause for DMEPOS CBP Supplier Contracts 

    A termination clause will be added to each DMEPOS CBP contract that could be utilized during a public health emergency, when CMS determines that credible evidence exists of an access problem for beneficiaries, and when CMS believes the termination of an entire DMEPOS CBP contract, the termination of a competition on a DMEPOS CBP contract, or the termination of a defined area(s) within a CBA could improve the situation for the applicable competition(s) or defined areas (for example, ZIP codes) within a CBA.

Beneficiary Protections and Program Safeguards:

• Savings:
  • The DMEPOS CBP reduces the amount Medicare pays for DMEPOS and brings the payment amounts more in line with that of a competitive market. In addition, contract suppliers must submit claims for competitive bidding items on an assignment basis.  In contrast, Medicare enrolled, fee-for-service DMEPOS suppliers in non-CBAs that have not elected to be participating suppliers under Medicare are not required to accept assignment, meaning they can charge any amount to the beneficiary. These factors help limit the financial burden on beneficiaries by reducing their out-of-pocket expenses.  
     
• Ensured Access:
  • When a physician specifically prescribes a particular brand name product or mode of delivery to avoid an adverse medical outcome, DMEPOS CBP contract suppliers are required either to furnish that item or mode of delivery, to assist the beneficiary in finding another contract supplier in the CBA that can provide that item or service, or to consult with the physician to find a suitable alternative product or mode of delivery for the beneficiary.  If the physician or treating practitioner determines that an alternative product is not acceptable, the contract supplier much furnish the item as prescribed.
  • Contract suppliers are required, as a term of contract, to furnish competitively bid items to beneficiaries throughout the entire CBA.
  • In accordance with 42 CFR § 414.422(c) and as a term of the DMEPOS CBP supplier contract, contract suppliers must make available the same range of products to beneficiaries that they make available to non-Medicare customers, otherwise known as the non-discrimination clause. For transparency, CMS posts a list of brands furnished by each contract supplier on our website. That list will be available to beneficiaries through 1-800-MEDICARE and www.medicare.gov. Through various enforcement activities, CMS monitors contract suppliers’ brands to ensure they are compliant with this contract requirement.
     
• Verifiable Payment Amounts:
  • The DMEPOS CBP utilizes a comprehensive process to check for non bona fide bids. We screen and evaluate all bids to ensure that they are rational and feasible for furnishing the lead item and all non-lead items in the product category. A bid(s) will be rejected if it is deemed non bona fide.  Our process for ensuring that CMS doesn’t accept low-ball or otherwise questionable bids is called the bona fide bid review process. A fact sheet that describes the bona fide bid review process is on the Competitive Bidding Implementation Contractor (CBIC) website.
     
• Customer Service:
  • Beneficiaries living in an area included in the DMEPOS CBP can obtain repairs of equipment they own from either a contract or non-contract supplier.
  • CMS provides dedicated customer service through the CMS Office of Program Operations and Local Engagement, local liaisons, and a Competitive Acquisition Ombudsman who closely monitor and respond to inquiries and complaints about the application of the program from beneficiaries who use items of DMEPOS under the program, contract suppliers who provide these items, and other stakeholders.
  • There is also a formal complaint process for beneficiaries, caregivers, providers and suppliers to report concerns about contract suppliers or other competitive bidding program issues.
     
• Quality Products:
  • Beneficiaries in CBAs receive products that meet applicable United States Food and Drug Administration (FDA) requirements from contract suppliers in their area. Contract suppliers are required to meet specific, detailed DMEPOS supplier standards in regulations at 42 CFR 424.57, quality standards established in accordance with section 1834(a)(20) of the Act, and applicable State and Federal licensing requirements and be accredited by an approved independent accrediting organization. For more information, go to: https://www.cms.gov/medicare/payment/fee-schedules/dmepos-competitive-bidding/quality-standards-accreditation-licensing. The standards address quality control procedures and product safety and effectiveness. For example, suppliers are responsible for delivery of items and must document that beneficiaries have been given necessary information and instructions on how to use Medicare-covered items safely and effectively. Suppliers must accept the return of any substandard items (less than full quality for the particular item or unsuitable items, inappropriate for the beneficiary at the time it was fitted and rented or sold).
     
• Transparency:
  • Over the years, our extensive real-time claims monitoring data has shown no negative impact on beneficiary health status based on measures such as hospitalizations, length of hospital stay, and number of emergency department visits compared to non-CBAs. This data is available on the CMS website.

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