CMS Releases Updated Fee Schedule for Non-Bid Area Suppliers Based on CARES Act

WASHINGTON, D.C. (May 5, 2020)—The COVID-19 stimulus legislation enacted in late March provides significant reimbursement relief for suppliers servicing Medicare beneficiaries in non-rural areas that are not subject to the bidding program. The reimbursement rate for items that have been receiving 100% of the competitive bidding adjusted fee schedule are getting a blended rate of 75% adjusted and 25% unadjusted (2015 fee schedule) rates. 

CMS has just released the new rates for non-rural/non-bid areas based on the legislation. These rates went into effect for claims with dates of service beginning March 6 and will be in place until the end of the public health emergency.

Across the board, there is a 32% increase for suppliers in non-rural, non-bid areas for the top DME items versus the former 2020 rates. AAHomecare’s original analysis just after the legislation was passed had estimated a 30% overall increase.

Further review of the new rates released by CMS shows:

• 39% increase for E1390 (oxygen concentrator);
• 41% increase for E0601 (CPAP); 
• and 9% increase for E1392 (portable oxygen concentrator). 

You can find AAHomecare’s region-by-region analysis and comparison with former rates for the top 25 HCPCS codes here: 

• Far West – CA, OR, NV, WA
• Great Lakes – IL, IN, MI, OH, WI
• Mideast – DE, DC, MD, NJ, NY, PA
• New England – CT, ME, MA, NH, RI, VT
• Plains – IA ,KS, MN, MO, NE, ND, SD
• Rocky Mountains – CO, ID, MT, UT, WY
• Southeast – AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV
• Southwest – AZ, NM, OK, TX

CMS has not indicated when suppliers will begin to receive retroactive payments. AAHomecare will monitor the retroactive payment process and continue to work with CMS and DME MACs to ensure the new payments will be implemented as soon as possible.

The new fee schedule can be found here.