AAHomecare Analyzes 2021 Medicare Fee Schedule

WASHINGTON, D.C. (December 18, 2020)—The Centers for Medicare & Medicaid Services (CMS) has published the CY 2021 Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule. As of Jan. 1, 2021, CMS will continue to apply the CARES Act relief rates for rural and nonrural areas. Rural areas will continue to receive the blended 50% adjusted and 50% unadjusted rates, and nonrural areas will receive the 75% adjusted and 25% unadjusted rates. Competitive Bidding Areas (CBAs) will also continue to receive the current gap period rates that were established by Round 1 2017 and Round 2 Recompete competitive bidding rounds. 

AAHomecare analyzed the top 25 HCPCS codes for each region and CBAs. Previously, CMS announced that rates in CBAs will receive a projected CPI-U adjustment of 0.6% increase for 2021, and the association can now confirm that this adjustment is reflected in the published rates. In the analysis, AAHoemcare also found that the 2021 CARES Act relief rates in place for non-CBAs will see a slight decrease compared to the current relief rates in place. On average, rural areas will see about a 0.2% decrease and nonrural areas will see a 0.5% decrease. 

However, the new 2021 CARES Act relief rates in nonrural areas are still significantly higher than what would have been in place if Congress did not expand rate relief earlier this year. On average, the rates are 31% higher for January 2021 compared to January 2020 rates. This significant relief has also broadly impacted other payers’ DMEPOS rates as many non-Medicare payers and state Medicaid programs base their rates off of the January 1st Medicare non-rural fee schedule each year.  

AAHomecare will be working with the state and regional associations to notify the impacted Medicaid programs of the new fee schedule and will continue to work with the industry to ensure these rates are applied where appropriate to commercial and Medicare Advantage plans. Providers should analyze their contracts to determine and notify the payers that have contracts tied to Medicare non-rural rates.   

AAHomecare is still internally reviewing these rates and will share new details or analysis as warranted. The association provided a region-by-region analysis for additional perspective: 

• 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
• Former CBAs