CMS Releases 2016 Fee Schedule Amounts

WASHINGTON, D.C. (November 24, 2015)—On November 23, the Centers for Medicare & Medicaid Services (CMS) announced the release of the 2016 Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts. The DMEPOS and Parenteral and Enteral Nutrition (PEN) public use files contain the 2016 fee schedule amounts for certain items that were adjusted based on information from the DMEPOS Competitive Bidding Program in accordance with sections 1834(a)(1)(F) and 1842(s)(3)(B) of the Social Security Act. The following is information associated with this change.

DMEPOS Competitive Bidding Program

Section 302 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established requirements for a new competitive bidding program for certain DMEPOS items and services.  The statute requires that “single payment amounts” replace the current Medicare DMEPOS fee schedule payment amounts for selected DMEPOS items in certain areas of the country. The single payment amounts are determined by using bids submitted by DMEPOS suppliers. The program is intended to set more appropriate DMEPOS payment amounts, which will reduce beneficiary out-of-pocket expenses and save the Medicare program money while ensuring beneficiary access to quality items and services.

There are currently competitive bidding programs in 99 Metropolitan Statistical Areas (MSAs) throughout the United States, including Honolulu, Hawaii. DMEPOS items and services that have been phased in under the programs thus far include:

• Oxygen and oxygen equipment
• Continuous positive airway pressure (CPAP) devices, single and bi-level
• Standard manual and power wheelchairs, scooters, and walkers
• Group 2 complex rehabilitative power wheelchairs
• Hospital beds, commode chairs, patient lifts, and seat lifts
• Support surfaces or pressure reducing mattresses and overlays
• Enteral nutrients, supplies, and equipment
• Negative pressure wound therapy pumps
• Infusion pumps
• Transcutaneous electrical nerve stimulation (TENS) devices
• Standard nebulizers

In addition, a national mail order program has been implemented for replacement of diabetic testing supplies such as test strips and lancets used with home blood glucose monitors. The single payment amounts established under this program are also used to set the fee schedule amounts for these diabetic testing supplies when they are picked up at local pharmacies.

For more information on DMEPOS Competitive Bidding please visit cms.gov/DMEPOSCompetitiveBid/.

View the full Fact Sheet on adjusted fee schedule amounts here.