CY 2020 Update for Durable Medical Equipment

CMS has revised previous updates of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule on January 3, 2020, to reflect an updated Change request (CR) that corrected the CY 2020 maintenance and servicing fee for certain oxygen equipment to $73.02 in the CR’ s business requirement 11570.9. The transmittal number, CR release date, and link to the transmittal also changed. All other information remains the same.

These changes are intended for providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items or services paid under the DMEPOS fee schedule provided to Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) updates the DMEPOS fee schedule on an annual basis in accordance with statute and regulations.

For CY 2020, the following applicable Fee Schedule Adjustment Methodologies and fee schedule amounts reflect the area in which the items and services are furnished.

Fee Schedule Amounts for Areas within the Contiguous United States

Claims with DOS Jan 1, 2019 – Dec 31, 2020

The adjusted fee schedule amounts for items furnished in non-competitively bid rural areas are a blend of 50 percent of the adjusted fee schedule amount and 50 percent of the unadjusted fee schedule amount for the item, the covered item updates specified in Sections 1834(a)(14) and 1842(s)(B) of the Act, for DME and enteral nutrition respectively updated.

The adjusted fee schedule amounts for items furnished in other non-competitively bid areas are based on 100 percent of the adjusted fee schedule amounts.

The CBP and SPAs generated from the CBP that are used to adjust the fee schedule amounts expired on January 1, 2019. Pursuant to 42 CFR Section 414.210(g)(4), the adjusted fee schedule amounts are increased by 1.6 percent on January 1, 2020, based on the percentage change in the CPI for all Urban Consumers (CPI-U) for the 12-month period ending June 30, 2019.

Fee Schedule Amounts for Areas outside the Contiguous United States

For the CY January 1, 2020 fee schedule update, the adjusted fee schedule amounts in non-bid areas will receive a CPI-U update per Section 414.210(g) of 1.6 percent due to the adjustments being based on SPAs from competitive bidding programs that are no longer in effect.

KE Modifier

Since mid of 2018, through the end of 2020, the rural and non-contiguous KE fee schedule amounts will be based on a blend of 50 percent of the adjusted fee schedule amount and 50 percent of the unadjusted KE fee schedule amount updated by the covered item updates specified in Sections 1834(a)(14) and 1842(s)(B) of the Act.

Instructions and a list of the applicable KE HCPCS codes are available in Transmittal 1630, CR 6270, from November 7, 2008.

The non-rural fees for these KE codes contain zeros on the fee schedule file since KE is not a valid option for areas without blended fees.

Fee Schedule Amounts for former Competitive Bidding Areas (CBAs)

Due to a delay, contracts will not be in effect January 1, 2019 – December 31, 2020, resulting in a gap in the CBP. During the gap period in the DMEPOS CBP, any Medicare-enrolled DMEPOS supplier may furnish any DMEPOS item, including items that were formerly included in the CBP.

The fee schedule amounts increase once every 12 months on the anniversary date of the first day after the contract period ended with the CPI-U. For CY 2020, the adjusted fee schedule amounts increase by the projected percentage change in the CPI-U of 2.4 percent for the 12-month period ending January 1, 2020. The ZIP code associated with the address used for pricing a DMEPOS claim determines the rural fee schedule payment that applies for codes with rural and non-rural adjusted fee schedule amounts.

Regarding coverage and payment indicators for codes in CMS’ 2020 HCPCS Update and DMEPOS Fee Schedule Files DME20-C.

The following CY 2020 DMEPOS fee schedule and ZIP code Public Use Files (PUFs) are available at the CMS website:

  • DMEPOS Fee schedule PUF
  • DME PEN Fee schedule PUF
  • DMEPOS Rural ZIP code PUF
  • Former CBA Fee schedule PUF
  • Former CBA National Mail Order diabetic testing supply fee schedule PUF
  • Former CBA ZIP Code PUF

ESRD Payment Regulations and Notices

Effective January 1, 2020, regulations on methodologies for establishing fees for new DMEPOS items are published in the CY 2020 End-Stage Renal Disease (ESRD)/ DMEPOS final rule, CMS-1713-F is available at CMS.

2020 Oxygen and Oxygen Equipment Fee Schedule Amounts

Consistent with the requirements set forth in Section 1834(a)(9)(D)(ii) of the Act, a budget neutrality offset must be applied to all oxygen payment classes and items including:

  • Stationary oxygen equipment and oxygen contents (E0424, E0439, E1390, and E1391)
  • Portable oxygen equipment add-on (E0431 and E0434)
  • OGPE add-on (E0433, E1392, and K0738)
  • Stationary contents (E0441 and E0442)
  • Portable contents (E0443 and E0444) and
  • Portable liquid contents for high flow patients (E0447)

For CY 2020, the offset percentage varies by geographic area and ranges from 7 to 10 percent in areas that are not former CBAs. Ref: Medicare Learning Network Matters

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