CMS Updates Fee Schedule with Adjustments to More than 900 HCPCS Codes

WASHINGTON, D.C. (March 3, 2021)—The Centers for Medicare & Medicaid Services (CMS) has published the Revised January 2021 DMEPOS Fee Schedule. In the announcement, CMS stated that errors were identified in the original fee schedule that was published on Dec. 11, 2020 and this new fee schedule includes adjustments to 919 HCPCS codes. 

AAHomecare reviewed the newly adjusted fee schedule and found that on average non-rural areas will be receiving 0.9% more and rural areas will receive 0.5% more than the original published 2021 fee schedule. CMS states that a small portion (8%) of the total fee schedule has more significant corrections, with adjustments ranging between -30% to +57% of the original 2021 fee schedule. Codes with significant changes are mostly codes with a KE modifier.

In AAHomecare’s analysis of the original 2021 fee schedule, the association found that the rates in rural and non-rural areas on average were slightly lower than the 2020 rates. AAHomecare was able to communicate concerns to CMS directly. In a press release the association related they are pleased CMS reviewed this input and adjusted the rates as appropriate. 

Suppliers that submitted claims prior to Jan. 26, 2021 that were paid at the incorrect amount may request the DME MAC to reprocess the claims. The DME MACs will be publishing information on how to request additional payment on those claims.  

Find the revisions here.